Provider Demographics
NPI:1992227078
Name:HILLARD, CHARMAINE LASHAWN
Entity type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:LASHAWN
Last Name:HILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARMAINE
Other - Middle Name:LASHAWN
Other - Last Name:METCALF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10400 CATON PL
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-1633
Mailing Address - Country:US
Mailing Address - Phone:405-740-2193
Mailing Address - Fax:
Practice Address - Street 1:10400 CATON PL
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-1633
Practice Address - Country:US
Practice Address - Phone:405-740-2193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty