Provider Demographics
NPI:1154310175
Name:GAGNON, CHARLES ALFRED (ED D, LPC-A)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALFRED
Last Name:GAGNON
Suffix:
Gender:M
Credentials:ED D, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 N 6TH ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4119
Mailing Address - Country:US
Mailing Address - Phone:318-680-0094
Mailing Address - Fax:
Practice Address - Street 1:403 N 6TH ST UNIT 2
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4119
Practice Address - Country:US
Practice Address - Phone:318-680-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72518101YP2500X, 101YP2500X
LA1973101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
33683OtherNTNL. CERT. COUNSELOR
LA1973OtherLPC STATE LICENSE
33683OtherCERT.CLIN. M.H. COUNSELOR