Individual
MS. CHARLENE JESSE CARLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
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
103T00000X
Psychologist
Primary
2754
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000395770
ANTHEM
—
Enumeration date
09/20/2006
Last updated
02/18/2008
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