Provider Demographics
NPI:1649755034
Name:AWADJIE, CHARLENE ABLA
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ABLA
Last Name:AWADJIE
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 1:316 CHASE HILL LN
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7082
Mailing Address - Country:US
Mailing Address - Phone:682-702-0586
Mailing Address - Fax:
Practice Address - Street 1:316 CHASE HILL LN
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7082
Practice Address - Country:US
Practice Address - Phone:682-702-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities