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Individual

CHARLES L CARR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD, LISAC

Contact information

Practice address
1790 N MASTICK WAY, SUITE D, NOGALES, AZ 85621-1135
(520) 394-4295
Mailing address
1790 N MASTICK WAY, SUITE D, NOGALES, AZ 85621-1135
(520) 394-4295

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11766
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11766
ARIZONA BOARD OF BEHAVIORAL HEALTH
AZ
Enumeration date
06/01/2009
Last updated
06/01/2009
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