Provider Demographics
NPI:1144974171
Name:LUTHER, CHARLES (MS, LPC, CRC, NCC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:LUTHER
Suffix:
Gender:M
Credentials:MS, LPC, CRC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5097 FELLOWSHIP DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3492
Mailing Address - Country:US
Mailing Address - Phone:770-335-8081
Mailing Address - Fax:
Practice Address - Street 1:4330 S LEE ST STE 800A
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5797
Practice Address - Country:US
Practice Address - Phone:678-866-4065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014297101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health