Individual
WANDA CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2479 GRASSY LICK RD, MT STERLING, KY 40353
(859) 498-6574
Mailing address
PO BOX 790, ASHLAND, KY 41105-0790
(606) 329-8588
(606) 329-8195
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45303849
—
KY
Enumeration date
03/16/2007
Last updated
07/08/2007
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