Provider Demographics
NPI:1861549404
Name:RADIOLA, CHARLES S (LPC, LCADC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:S
Last Name:RADIOLA
Suffix:
Gender:M
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6542
Mailing Address - Country:US
Mailing Address - Phone:732-539-2924
Mailing Address - Fax:
Practice Address - Street 1:26 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-6542
Practice Address - Country:US
Practice Address - Phone:732-539-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00078200101YA0400X
NJ37PC00290000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)