Healthcare Provider Details

I. General information

NPI: 1306808100
Provider Name (Legal Business Name): CHARLENE SPEARS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W PINHOOK RD 305
LAFAYETTE LA
70503-2445
US

IV. Provider business mailing address

PO BOX 1254
BROUSSARD LA
70518-1254
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-9150
  • Fax: 337-237-9127
Mailing address:
  • Phone: 337-234-5656
  • Fax: 337-234-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2225
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: