Individual
CHARLES SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LAC
Contact information
Practice address
1585 3RD ST, BJACH, FORT POLK, LA 71459-5102
(337) 531-1972
Mailing address
1585 3RD ST, BJACH, FORT POLK, LA 71459-5102
(337) 531-3755
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
641
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1863
LPC
LA
01
—
641
LAC
LA
Enumeration date
09/20/2006
Last updated
07/08/2007
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