Provider Demographics
NPI:1528727443
Name:BEARD, CHARLES (MS, LPC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BEARD
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11835 CANON BLVD STE B107
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2570
Mailing Address - Country:US
Mailing Address - Phone:757-525-7690
Mailing Address - Fax:
Practice Address - Street 1:11835 CANON BLVD STE B107
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2570
Practice Address - Country:US
Practice Address - Phone:757-525-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health