Provider Demographics
NPI:1902307432
Name:PICKERING, CHARLES (CT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:PICKERING
Suffix:
Gender:M
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-8998
Mailing Address - Country:US
Mailing Address - Phone:740-816-2287
Mailing Address - Fax:
Practice Address - Street 1:950 MEADOW DR
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1389
Practice Address - Country:US
Practice Address - Phone:419-949-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700541-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health