Individual
DESTINEE CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 S ACADIAN THRUWAY, BATON ROUGE, LA 70806-6900
(225) 223-6968
Mailing address
1379 N FOSTER DR, BATON ROUGE, LA 70806-1816
(225) 636-0806
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/20/2017
Last updated
11/11/2019
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