Organization
C JESSE CARLOCK PH D & ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHARLENE JESSE CARLOCK PHD (OWNER /PSYCHOLOGIST)
(937) 256-0500
Entity
Organization
Contact information
Practice address
1105 WATERVLIET AVE, DAYTON, OH 45420
(937) 256-0500
(937) 256-2136
Mailing address
1105 WATERVLIET AVE, DAYTON, OH 45420
(937) 256-0500
(937) 256-2136
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
09/20/2006
Last updated
10/13/2009
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