Provider Demographics
NPI:1851003719
Name:SPRUEL CHARLES, DEBRA (PSYD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:SPRUEL CHARLES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6962 TITIAN AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-2749
Mailing Address - Country:US
Mailing Address - Phone:225-284-7025
Mailing Address - Fax:
Practice Address - Street 1:6962 TITIAN AVE APT 7
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2749
Practice Address - Country:US
Practice Address - Phone:225-284-7025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADC860062103TC1900X, 171M00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No171M00000XOther Service ProvidersCase Manager/Care Coordinator