Provider Demographics
NPI:1376200378
Name:IRVIN, CHERITA LACHELLE
Entity Type:Individual
Prefix:
First Name:CHERITA
Middle Name:LACHELLE
Last Name:IRVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 RUE NICOLE
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-8015
Mailing Address - Country:US
Mailing Address - Phone:225-407-5937
Mailing Address - Fax:
Practice Address - Street 1:9410 LINDALE AVE STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4160
Practice Address - Country:US
Practice Address - Phone:225-768-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator