Provider Demographics
NPI:1043822034
Name:LAFORTUNE, CHARMAGNE ALEE (MSED)
Entity Type:Individual
Prefix:
First Name:CHARMAGNE
Middle Name:ALEE
Last Name:LAFORTUNE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 IVANHOE ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1935
Mailing Address - Country:US
Mailing Address - Phone:269-319-9405
Mailing Address - Fax:
Practice Address - Street 1:3120 WINDSOR CT STE B
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-5556
Practice Address - Country:US
Practice Address - Phone:574-267-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health