Provider Demographics
NPI:1962399857
Name:HARVEY, CHARLIS MADONNA
Entity type:Individual
Prefix:
First Name:CHARLIS
Middle Name:MADONNA
Last Name:HARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1566 S LABURNUM AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-5802
Mailing Address - Country:US
Mailing Address - Phone:804-238-1648
Mailing Address - Fax:
Practice Address - Street 1:13354 MIDLOTHIAN TPKE STE 200
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4258
Practice Address - Country:US
Practice Address - Phone:804-277-9355
Practice Address - Fax:804-210-2443
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014877101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health