Provider Demographics
NPI:1447626882
Name:TERRACINA, CHARLES (LPC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:TERRACINA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ENERGY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3816
Mailing Address - Country:US
Mailing Address - Phone:337-261-8781
Mailing Address - Fax:337-261-8784
Practice Address - Street 1:200 ENERGY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3816
Practice Address - Country:US
Practice Address - Phone:337-261-8781
Practice Address - Fax:337-261-8784
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA627101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA12959Medicaid