Provider Demographics
NPI:1538941034
Name:NEWSOME, CHARLENE (CPRS, QMHP)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:CPRS, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 DENBIGH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4240
Mailing Address - Country:US
Mailing Address - Phone:757-218-1918
Mailing Address - Fax:757-210-4021
Practice Address - Street 1:558 DENBIGH BLVD STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4240
Practice Address - Country:US
Practice Address - Phone:757-218-1918
Practice Address - Fax:757-210-4021
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4010175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist