Healthcare Provider Details

I. General information

NPI: 1336595420
Provider Name (Legal Business Name): KATHLEEN CHAREST LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 SPAIN RD NE STE 209C
ALBUQUERQUE NM
87109-3130
US

IV. Provider business mailing address

8205 SPAIN RD NE STE 209C
ALBUQUERQUE NM
87109-3130
US

V. Phone/Fax

Practice location:
  • Phone: 505-675-4422
  • Fax:
Mailing address:
  • Phone: 505-675-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0216011
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0181271
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: