Provider Demographics
NPI:1447954631
Name:DEROUEN, CHARLI RHEA (MS, LAC, CCS)
Entity type:Individual
Prefix:
First Name:CHARLI
Middle Name:RHEA
Last Name:DEROUEN
Suffix:
Gender:F
Credentials:MS, LAC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SAINT JULIEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4622
Mailing Address - Country:US
Mailing Address - Phone:337-366-6050
Mailing Address - Fax:
Practice Address - Street 1:406 SAINT JULIEN AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4622
Practice Address - Country:US
Practice Address - Phone:337-366-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3384101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)