Healthcare Provider Details

I. General information

NPI: 1447626882
Provider Name (Legal Business Name): CHARLES TERRACINA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ENERGY PKWY
LAFAYETTE LA
70508-3816
US

IV. Provider business mailing address

200 ENERGY PKWY
LAFAYETTE LA
70508-3816
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-8781
  • Fax: 337-261-8784
Mailing address:
  • Phone: 337-261-8781
  • Fax: 337-261-8784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number627
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: