Provider Demographics
NPI:1013295559
Name:COLSTON, CONSUELA MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CONSUELA
Middle Name:MARIE
Last Name:COLSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 GRIFFIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-1411
Mailing Address - Country:US
Mailing Address - Phone:337-377-8008
Mailing Address - Fax:337-326-4443
Practice Address - Street 1:2009 GRIFFIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-1411
Practice Address - Country:US
Practice Address - Phone:337-377-8008
Practice Address - Fax:337-326-4443
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56461041C0700X, 104100000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)