Individual
CHARLES ROBERT YATES JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3821 SOUTHERN AVE, SHREVEPORT, LA 71106-1033
(318) 946-8157
Mailing address
3821 SOUTHERN AVE, SHREVEPORT, LA 71106-1033
(318) 946-8157
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285998716
—
LA
Enumeration date
06/09/2020
Last updated
06/16/2020
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