Individual
CHARLOTTE IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1921 DULLES DR, LAFAYETTE, LA 70506-2716
(337) 223-9487
(888) 511-5650
Mailing address
9843 BLAINE LAKE DR, HOUSTON, TX 77086-2878
(337) 257-9065
(888) 511-5650
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12345678999966655525
INTERN NUMBER
—
01
—
PLC6505
LICENSE #
LA
Enumeration date
01/27/2021
Last updated
02/20/2021
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