Provider Demographics
NPI:1285031377
Name:COY, LACHARLA (LPN)
Entity type:Individual
Prefix:
First Name:LACHARLA
Middle Name:
Last Name:COY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15588 BRANDT ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-3209
Mailing Address - Country:US
Mailing Address - Phone:734-272-7689
Mailing Address - Fax:313-836-1190
Practice Address - Street 1:15588 BRANDT ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-3209
Practice Address - Country:US
Practice Address - Phone:734-272-7689
Practice Address - Fax:313-836-1190
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703091414101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor