Provider Demographics
NPI:1023999729
Name:CHARITON, JENNIFER AMY
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AMY
Last Name:CHARITON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:CHARITON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LAC
Mailing Address - Street 1:601 GLENEAGLE CT
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-8463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1002 MCCLAIN RD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6737
Practice Address - Country:US
Practice Address - Phone:801-472-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2508005101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor