Doctor Name: | CHARLES SMITH |
NPI Number: | 1215035894 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC, LAC |
License Number: | 641 |
Business Practice Address: | 1585 3rd St Bjach Fort Polk, LA - 714595102 |
Business Phone Number: | 3375311972 |
Business Fax Number: | |
Mailing Address: | 1585 3rd St, Bjach FORT POLK |
State: | LA |
Postal Code: | 714595102 |
Phone Number: | 3375313755 |
Fax Number: | |
NPI Enumeration Date: | 09/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 641 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |