Carlock, Charlene Jesse
Carlock, Charlene Jesse is an individual health care provider with primary practice located at 1105 Watervliet Ave , Dayton OH 45420. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Carlock, Charlene Jesse can be contacted via phone (937) 256-0500.Contact Information
Primary practice address
1105 Watervliet Ave
Dayton OH 45420
Phone: (937) 256-0500
Fax: (937) 256-2136
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 2754 | Ohio |
Profile Details
| NPI number | 1902904295 |
|---|---|
| LBN Legal business name | Carlock, Charlene Jesse |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 20th, 2006 |
| Last updated | Feb 18th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902904295 | NPPES |
| Other | 000000395770 | ANTHEM |
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