Provider Demographics
NPI:1093003899
Name:SCRIVEN CHARLES, LATONYA (LCSW)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:SCRIVEN CHARLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12726
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2726
Mailing Address - Country:US
Mailing Address - Phone:337-353-2129
Mailing Address - Fax:
Practice Address - Street 1:1605 MURRAY ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-6890
Practice Address - Country:US
Practice Address - Phone:318-443-9035
Practice Address - Fax:318-443-9037
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8788104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker