Provider Demographics
NPI:1033409909
Name:MONTGOMERY, CHARLETTA S (LCSW-BACS, BCD)
Entity type:Individual
Prefix:MRS
First Name:CHARLETTA
Middle Name:S
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LCSW-BACS, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 HOWELL PLACE BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807-5256
Mailing Address - Country:US
Mailing Address - Phone:225-774-1120
Mailing Address - Fax:225-358-1496
Practice Address - Street 1:7855 HOWELL PLACE BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-5256
Practice Address - Country:US
Practice Address - Phone:225-774-1120
Practice Address - Fax:225-358-1496
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical