Provider Demographics
NPI:1457603292
Name:BOOKER-ALLEN, CHARISSE CELESTE
Entity Type:Individual
Prefix:MRS
First Name:CHARISSE
Middle Name:CELESTE
Last Name:BOOKER-ALLEN
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 1:13101 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2216
Mailing Address - Country:US
Mailing Address - Phone:734-785-7700
Mailing Address - Fax:
Practice Address - Street 1:13101 ALLEN RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2216
Practice Address - Country:US
Practice Address - Phone:734-785-7700
Practice Address - Fax:734-287-4602
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2014-02-26
Deactivation Date:2013-06-05
Deactivation Code:
Reactivation Date:2014-02-26
Provider Licenses
StateLicense IDTaxonomies
MI6802065475101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health