Provider Demographics
NPI:1659620441
Name:CHARLES-POLYCARPE, STACEYANNE (LCSW)
Entity type:Individual
Prefix:
First Name:STACEYANNE
Middle Name:
Last Name:CHARLES-POLYCARPE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11526 MEADOWCHASE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4909
Mailing Address - Country:US
Mailing Address - Phone:347-308-4351
Mailing Address - Fax:
Practice Address - Street 1:11526 MEADOWCHASE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4909
Practice Address - Country:US
Practice Address - Phone:347-308-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW185411041C0700X
TXSW1101311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical