Provider Demographics
NPI:1710515333
Name:ARCHULETTA, CHARLOTTE (LPC/MHSP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:ARCHULETTA
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:ARCHULETTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC/MHSP
Mailing Address - Street 1:PO BOX 3721
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-3721
Mailing Address - Country:US
Mailing Address - Phone:615-852-5055
Mailing Address - Fax:
Practice Address - Street 1:1604 WESTGATE CIR STE 240
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8578
Practice Address - Country:US
Practice Address - Phone:615-852-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000003610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty