Provider Demographics
NPI:1609485515
Name:SPROLES, CHARLEEN BROWN (LPC)
Entity Type:Individual
Prefix:
First Name:CHARLEEN
Middle Name:BROWN
Last Name:SPROLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-4619
Mailing Address - Country:US
Mailing Address - Phone:601-941-7002
Mailing Address - Fax:
Practice Address - Street 1:434 KATHERINE DR STE B
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8811
Practice Address - Country:US
Practice Address - Phone:601-941-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional