Provider Demographics
NPI:1699463315
Name:CLARE J CHARLES LISW-CP LLC
Entity type:Organization
Organization Name:CLARE J CHARLES LISW-CP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SELIGER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:312-501-8770
Mailing Address - Street 1:6 POST MILL RD
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1232
Mailing Address - Country:US
Mailing Address - Phone:916-216-1386
Mailing Address - Fax:
Practice Address - Street 1:6 POST MILL RD
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1232
Practice Address - Country:US
Practice Address - Phone:916-216-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health