Provider Demographics
NPI:1932089182
Name:WOOLDRIDGE, CHARLTON (BSW, CSA, APSS)
Entity type:Individual
Prefix:
First Name:CHARLTON
Middle Name:
Last Name:WOOLDRIDGE
Suffix:
Gender:M
Credentials:BSW, CSA, APSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 FREEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-5509
Mailing Address - Country:US
Mailing Address - Phone:270-566-0691
Mailing Address - Fax:
Practice Address - Street 1:137 FREEMAN AVE
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-5509
Practice Address - Country:US
Practice Address - Phone:270-566-0691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker