| Doctor Name: | MS. CHARLAYNE LACKING |
| NPI Number: | 1326146093 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 51299 |
| Business Practice Address: | 1585 3rd St Fort Polk, LA - 714595102 |
| Business Phone Number: | 3375313922 |
| Business Fax Number: | |
| Mailing Address: | 708 Woodland Dr, LEESVILLE |
| State: | LA |
| Postal Code: | 714463614 |
| Phone Number: | |
| 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: | 51299 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |