Provider Demographics
NPI:1639761497
Name:SMITH, CHARLENE D
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:D
Last Name:SMITH
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:DESTINED FOR OPTIONS
Mailing Address - Street 2:908 WEST JUDGE PEREZ DRIVE SUITE C
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043
Mailing Address - Country:US
Mailing Address - Phone:504-715-1182
Mailing Address - Fax:
Practice Address - Street 1:908 W JUDGE PEREZ DR STE C
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4773
Practice Address - Country:US
Practice Address - Phone:504-715-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator