| Charis Foundation Inc | |
|
9621 Six Forks Rd Raleigh NC 27615-1628 | |
| (919) 671-4374 | |
| Not Available |
| Full Name | Charis Foundation Inc |
|---|---|
| Speciality | Psychologist |
| Location | 9621 Six Forks Rd, Raleigh, North Carolina |
| Authorized Official Name and Position | Frank Green (FOUNDER) |
| Authorized Official Contact | 9195569141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charis Foundation Inc 7716 Fall Branch Ct Wake Forest NC 27587-8719 Ph: (919) 556-9141 | Charis Foundation Inc 9621 Six Forks Rd Raleigh NC 27615-1628 Ph: (919) 671-4374 |
| NPI Number | 1750683694 |
|---|---|
| Provider Enumeration Date | 11/29/2010 |
| Last Update Date | 11/29/2010 |
| Medicare PECOS PAC ID | 0244411882 |
|---|---|
| Medicare Enrollment ID | O20110302000169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750683694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 3964 (North Carolina) | Primary |
| 106H00000X | Marriage & Family Therapist | 488 (North Carolina) | Secondary |
| Provider Name | Corinne N Green |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760713416 PECOS PAC ID: 9638203532 Enrollment ID: I20100813000753 |
| Provider Name | Robert Lewis Stuckey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831564079 PECOS PAC ID: 3870853781 Enrollment ID: I20180213002614 |
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