Provider Demographics
NPI:1194354985
Name:CHARLES, NAKITA M (MS LMFT)
Entity type:Individual
Prefix:MRS
First Name:NAKITA
Middle Name:M
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 GRIFFIN RD STE 304C
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3300
Mailing Address - Country:US
Mailing Address - Phone:305-206-2142
Mailing Address - Fax:
Practice Address - Street 1:10400 GRIFFIN RD STE 304C
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3300
Practice Address - Country:US
Practice Address - Phone:305-206-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMT3701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty