Provider Demographics
NPI:1689604662
Name:RAHAIM, CHARLOTTE MCILWAIN (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MCILWAIN
Last Name:RAHAIM
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-5049
Mailing Address - Country:US
Mailing Address - Phone:601-788-6319
Mailing Address - Fax:
Practice Address - Street 1:1003 W PINE ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-5049
Practice Address - Country:US
Practice Address - Phone:601-584-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0367101YP2500X
MSTO122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist