Provider Demographics
NPI:1699468942
Name:CCHARLES COUNSELING LLC
Entity type:Organization
Organization Name:CCHARLES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, CADC
Authorized Official - Phone:617-882-2282
Mailing Address - Street 1:450 PROVIDENCE HWY # 1064
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6815
Mailing Address - Country:US
Mailing Address - Phone:617-882-2282
Mailing Address - Fax:617-882-2871
Practice Address - Street 1:450 PROVIDENCE HWY #1064
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:617-882-2282
Practice Address - Fax:617-882-2871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty