Basic Information
| Provider Information | |||||||||
| NPI: | 1386261774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAPP | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | LOFLIN | ||||||||
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| Credential: | LCSWA, LCASA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 E FRANKLIN ST APT 32 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362872609 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3125 POPLARWOOD CT STE 203 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276046445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197876131 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2020 | ||||||||
| LastUpdateDate: | 07/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCAS-26521 | NC | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.