Individual
CHARLES JACOB STOCKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2473 BENCH REEF PL, HENDERSON, NV 89052-5202
(702) 672-8434
Mailing address
2473 BENCH REEF PL, HENDERSON, NV 89052-5202
(702) 672-8434
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
10050-M
NV
Other
Enumeration date
02/18/2020
Last updated
06/07/2022
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