Provider Demographics
NPI:1669723995
Name:CONIGLIO, CHARLOTTE R (MA, NCC)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:R
Last Name:CONIGLIO
Suffix:
Gender:M
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3101
Mailing Address - Country:US
Mailing Address - Phone:985-201-8753
Mailing Address - Fax:
Practice Address - Street 1:401 FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-3101
Practice Address - Country:US
Practice Address - Phone:985-201-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA298051101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor