Provider Demographics
NPI:1265040422
Name:CHARETTE, DARRELL C (ALCOHOL AND DRUG COU)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:C
Last Name:CHARETTE
Suffix:
Gender:M
Credentials:ALCOHOL AND DRUG COU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 520
Mailing Address - Street 2:1105 SHELDON SOURAY AVENUE
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0520
Mailing Address - Country:US
Mailing Address - Phone:701-477-3121
Mailing Address - Fax:701-477-8925
Practice Address - Street 1:1105 SHELDON SOURAY AVENUE
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-0520
Practice Address - Country:US
Practice Address - Phone:701-477-3121
Practice Address - Fax:701-477-8925
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program