Provider Demographics
NPI:1699458992
Name:CHARLES, PRINCESS (MST)
Entity type:Individual
Prefix:DR
First Name:PRINCESS
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 TORONTO DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-4111
Mailing Address - Country:US
Mailing Address - Phone:832-954-3329
Mailing Address - Fax:
Practice Address - Street 1:407 TORONTO DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-4111
Practice Address - Country:US
Practice Address - Phone:832-954-3329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator