Provider Demographics
NPI:1225868979
Name:COUNSELMAN, CHARLES BOYD (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:BOYD
Last Name:COUNSELMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 KEYSTONE PARK DR UNIT 50
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6102
Mailing Address - Country:US
Mailing Address - Phone:336-707-1915
Mailing Address - Fax:
Practice Address - Street 1:705 KEYSTONE PARK DR UNIT 50
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6102
Practice Address - Country:US
Practice Address - Phone:336-707-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0173991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical