Provider Demographics
NPI:1316540883
Name:CHAMPION, CARRIE (LCDC, LPC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:LCDC, LPC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:ROSBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24303 W OAK DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-5673
Mailing Address - Country:US
Mailing Address - Phone:615-906-4166
Mailing Address - Fax:
Practice Address - Street 1:24303 W OAK DR
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-5673
Practice Address - Country:US
Practice Address - Phone:615-906-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13825101YA0400X
TX81264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)