Individual
LISA MARY CHARLEBOIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
11344 COLOMA RD, SUITE 250, GOLD RIVER, CA 95670-4457
(916) 552-6122
(916) 852-5838
Mailing address
11344 COLOMA RD, SUITE 250, GOLD RIVER, CA 95670-4457
(916) 552-6122
(916) 852-5838
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCS 15125
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049887
MANAGED HEALTH NETWORK ID
CA
01
—
LCS151251
BLUE SHIELD ID #
CA
Enumeration date
07/19/2006
Last updated
07/08/2007
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