Provider Demographics
NPI:1912252727
Name:CHAMPALOUX, ARIEL REINE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:ARIEL
Middle Name:REINE
Last Name:CHAMPALOUX
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 1:665 MISSION BAY DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-5701
Mailing Address - Country:US
Mailing Address - Phone:321-557-6263
Mailing Address - Fax:
Practice Address - Street 1:665 MISSION BAY DR
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-5701
Practice Address - Country:US
Practice Address - Phone:321-557-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 101711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical