Provider Demographics
NPI:1154546570
Name:HOWELL, CHARITY LATRELLE (SPEECH-LANGUAGE PATH)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:LATRELLE
Last Name:HOWELL
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 TELFAIR LN
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5225
Mailing Address - Country:US
Mailing Address - Phone:404-510-2453
Mailing Address - Fax:770-957-9741
Practice Address - Street 1:119 TELFAIR LN
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5225
Practice Address - Country:US
Practice Address - Phone:404-510-2453
Practice Address - Fax:404-510-2453
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000837438LMedicaid
GA000837438CMedicaid
GA000837438AMedicaid