Provider Demographics
NPI:1164987509
Name:DEAN, CHARVE L
Entity Type:Individual
Prefix:
First Name:CHARVE
Middle Name:L
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 MT DIABLO BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3780
Mailing Address - Country:US
Mailing Address - Phone:510-665-9010
Mailing Address - Fax:
Practice Address - Street 1:5000 NE 72ND AVE APT K67
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-8170
Practice Address - Country:US
Practice Address - Phone:360-773-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician