Provider Demographics
NPI:1386923746
Name:CHARLESTON, LETIZIA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:LETIZIA
Middle Name:MARIE
Last Name:CHARLESTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LETIZIA
Other - Middle Name:MARIE
Other - Last Name:LANZILLOTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:131 W SEAWAY DR
Mailing Address - Street 2:STE 200
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3761
Mailing Address - Country:US
Mailing Address - Phone:231-375-8065
Mailing Address - Fax:231-375-8063
Practice Address - Street 1:920 DIANA ST
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1987
Practice Address - Country:US
Practice Address - Phone:231-845-6294
Practice Address - Fax:231-845-7095
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010623941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical