Individual
CHARLES G JACQUES III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, LMT, LMFT
Contact information
Practice address
8017 JEFFERSON HWY STE A3, BATON ROUGE, LA 70809-1681
(225) 924-4903
Mailing address
8017 JEFFERSON HWY STE A3, BATON ROUGE, LA 70809-1681
(225) 924-4903
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
200
LA
Other
Enumeration date
05/30/2007
Last updated
07/08/2007
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