Provider Demographics
NPI:1902954498
Name:CHARLES, DESERIE MELISSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DESERIE
Middle Name:MELISSA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 VERNON SQUARE DR
Mailing Address - Street 2:#203
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-7545
Mailing Address - Country:US
Mailing Address - Phone:571-251-8961
Mailing Address - Fax:
Practice Address - Street 1:5691 COLUMBIA PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2887
Practice Address - Country:US
Practice Address - Phone:703-998-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003552103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical