Provider Demographics
NPI:1164919601
Name:CARMOUCHE, CHARENYIA CHARKEIJAH
Entity Type:Individual
Prefix:
First Name:CHARENYIA
Middle Name:CHARKEIJAH
Last Name:CARMOUCHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12376 BUCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-6766
Mailing Address - Country:US
Mailing Address - Phone:504-478-0395
Mailing Address - Fax:
Practice Address - Street 1:6744 HANKS DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70812-3523
Practice Address - Country:US
Practice Address - Phone:504-478-0395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010664538101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health