MEDICARE: LASHICA SHARTRECE CHARLEY M.S,

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
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235486093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHICA SHARTRECE CHARLEY M.S,

Provider Business Mailing Address
First Line	:	33 PEN HAVEN DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32506-6404
Country	:	US
Telephone Number	:	850-712-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 BAYOU BLVD STE 34
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2682
Country	:	US
Telephone Number	:	850-471-0017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2012
Last Update Date	:	08/12/2012

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