Provider Demographics
NPI:1235486093
Name:CHARLEY, LASHICA SHARTRECE (MS,)
Entity Type:Individual
Prefix:
First Name:LASHICA
Middle Name:SHARTRECE
Last Name:CHARLEY
Suffix:
Gender:F
Credentials:MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 PEN HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-6404
Mailing Address - Country:US
Mailing Address - Phone:850-712-0885
Mailing Address - Fax:
Practice Address - Street 1:4400 BAYOU BLVD STE 34
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2682
Practice Address - Country:US
Practice Address - Phone:850-471-0017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health