Provider Demographics
NPI:1356062640
Name:IRVIN, CHARLITA YVETTE (LMSW)
Entity type:Individual
Prefix:
First Name:CHARLITA
Middle Name:YVETTE
Last Name:IRVIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 S CLEARVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-3401
Mailing Address - Country:US
Mailing Address - Phone:504-635-8612
Mailing Address - Fax:
Practice Address - Street 1:822 S. CLEARVIEW PARKWAY
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123
Practice Address - Country:US
Practice Address - Phone:504-635-8612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6603L1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool