Provider Demographics
NPI:1245787985
Name:CHARBONNET, JAMES MARCOUR III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MARCOUR
Last Name:CHARBONNET
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6320 SOUTHWEST BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-6965
Mailing Address - Country:US
Mailing Address - Phone:817-307-9093
Mailing Address - Fax:
Practice Address - Street 1:6320 SOUTHWEST BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-6965
Practice Address - Country:US
Practice Address - Phone:817-307-9093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical