Provider Demographics
NPI:1114264298
Name:DEVILLE, CHARLES LAVIE JR (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LAVIE
Last Name:DEVILLE
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 FORT ROOTS DR
Mailing Address - Street 2:MENTAL HEALTH SERVICE (116/NLR)
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-1709
Mailing Address - Country:US
Mailing Address - Phone:501-257-3190
Mailing Address - Fax:501-257-3180
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:MENTAL HEALTH SERVICE (116/NLR)
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-3190
Practice Address - Fax:501-257-3180
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1203-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical