Provider Demographics
NPI:1932448461
Name:EDWARDS, CHARLETTE (MSPH, LAC, AADC, BA)
Entity type:Individual
Prefix:
First Name:CHARLETTE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MSPH, LAC, AADC, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 LINE AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4630
Mailing Address - Country:US
Mailing Address - Phone:318-519-4802
Mailing Address - Fax:
Practice Address - Street 1:1545 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4600
Practice Address - Country:US
Practice Address - Phone:318-519-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst