Provider Demographics
NPI:1528575990
Name:SULLEN, CHARALDA MONIQUE
Entity Type:Individual
Prefix:
First Name:CHARALDA
Middle Name:MONIQUE
Last Name:SULLEN
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 1:2962 GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7912
Mailing Address - Country:US
Mailing Address - Phone:504-261-5590
Mailing Address - Fax:
Practice Address - Street 1:3604 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119
Practice Address - Country:US
Practice Address - Phone:504-822-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-06
Last Update Date:2018-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health