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NPI Code Detail

MEDICARE: MS. CHARLOTTE RENEE EDWARDS

MEDICARE: MS. CHARLOTTE RENEE EDWARDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1083472450
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHARLOTTE RENEE EDWARDS
Provider Business Mailing Address
First Line : 7000 BOBTAIL DR
Second Line :
City : SHREVEPORT
State : LA
Zip : 71129-3418
Country : US
Telephone Number : 318-393-9724
Fax Number :
Provider Business Practice Location Address
First Line : 1111 W MOCKINGBIRD LN STE 480
Second Line :
City : DALLAS
State : TX
Zip : 75247-5062
Country : US
Telephone Number : 318-393-9724
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2024
Last Update Date : 03/11/2024

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