Provider Demographics
NPI:1447661798
Name:CHARETTE, ALLISON MARTHA (EDS, NCSP)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:MARTHA
Last Name:CHARETTE
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:MARTHA
Other - Last Name:KOLBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS, NCSP
Mailing Address - Street 1:120 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:806 RACETIME RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-7631
Practice Address - Country:US
Practice Address - Phone:920-980-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1983970103TS0200X
IN10193502103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool