Provider Demographics
NPI:1043942873
Name:CHENEY, CHARLOTTE HEESACKER (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:HEESACKER
Last Name:CHENEY
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4023
Mailing Address - Country:US
Mailing Address - Phone:971-238-4408
Mailing Address - Fax:
Practice Address - Street 1:2950 SE STARK ST STE 130
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3082
Practice Address - Country:US
Practice Address - Phone:971-270-0167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORR7900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health