Provider Demographics
NPI:1619004215
Name:VANHORN, CHARLES E (LISW-S)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:VANHORN
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:E
Other - Last Name:VANHORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:305 1/2 4TH ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5396
Mailing Address - Country:US
Mailing Address - Phone:304-481-1357
Mailing Address - Fax:
Practice Address - Street 1:305 1/2 4TH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5396
Practice Address - Country:US
Practice Address - Phone:304-481-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVI.0009470-SUPV1041C0700X
WVDP009388091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical