Provider Demographics
NPI:1205042835
Name:TIGNER, CHARLOTTE ANDREA (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:ANDREA
Last Name:TIGNER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MRS
Other - First Name:CHARLOTTE
Other - Middle Name:ANDREA
Other - Last Name:TIGNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:3904 RAGUET ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1987
Mailing Address - Country:US
Mailing Address - Phone:936-371-0699
Mailing Address - Fax:
Practice Address - Street 1:3904 RAGUET ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1987
Practice Address - Country:US
Practice Address - Phone:936-371-0699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health