Provider Demographics
NPI:1851829063
Name:CELESTINE, TESSIE SHARINE
Entity Type:Individual
Prefix:MRS
First Name:TESSIE
Middle Name:SHARINE
Last Name:CELESTINE
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 1:1202 KIRKMAN ST STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5391
Mailing Address - Country:US
Mailing Address - Phone:337-990-5305
Mailing Address - Fax:337-990-5306
Practice Address - Street 1:1202 KIRKMAN ST STE C
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5391
Practice Address - Country:US
Practice Address - Phone:337-990-5305
Practice Address - Fax:855-239-9737
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator