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
Fax: (937) 256-2136
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902904295 NPPES
Other 000000395770 ANTHEM

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