Provider Demographics
NPI:1326422890
Name:CHARLES, MICHON RICA (LPC)
Entity Type:Individual
Prefix:
First Name:MICHON
Middle Name:RICA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHON
Other - Middle Name:RICA
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:11220 W LOOP 1604 N STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6600
Mailing Address - Country:US
Mailing Address - Phone:210-382-5893
Mailing Address - Fax:210-783-1777
Practice Address - Street 1:6502 BANDERA RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1445
Practice Address - Country:US
Practice Address - Phone:210-838-4757
Practice Address - Fax:210-783-1777
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional