Provider Demographics
NPI:1336595420
Name:CHAREST, KATHLEEN (LPCC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CHAREST
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8205 SPAIN RD NE STE 209C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3130
Mailing Address - Country:US
Mailing Address - Phone:505-675-4422
Mailing Address - Fax:
Practice Address - Street 1:8205 SPAIN RD NE STE 209C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3130
Practice Address - Country:US
Practice Address - Phone:505-675-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0216011101YM0800X
NMT-0181271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health