Provider Demographics
NPI:1619620804
Name:WESTBROOK, CHARLOTTE LOUISE
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:LOUISE
Last Name:WESTBROOK
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 1:610 ROSS LN
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37892-2267
Mailing Address - Country:US
Mailing Address - Phone:423-319-6551
Mailing Address - Fax:
Practice Address - Street 1:607 CLIFTY ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1765
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)