Provider Demographics
NPI:1104273796
Name:CHARLES, ANGELIA
Entity type:Individual
Prefix:
First Name:ANGELIA
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S COLLEGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3213
Mailing Address - Country:US
Mailing Address - Phone:337-205-6073
Mailing Address - Fax:337-264-9282
Practice Address - Street 1:315 S COLLEGE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-205-6073
Practice Address - Fax:337-264-9282
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator