Provider Demographics
NPI:1558862110
Name:CHARLES, SHEKITA MARIE
Entity Type:Individual
Prefix:
First Name:SHEKITA
Middle Name:MARIE
Last Name:CHARLES
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 1:2742 EDMONDS ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-1437
Mailing Address - Country:US
Mailing Address - Phone:702-884-5222
Mailing Address - Fax:
Practice Address - Street 1:3925 N MLK BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7673
Practice Address - Country:US
Practice Address - Phone:702-916-1085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst