Provider Demographics
NPI:1407617962
Name:CHARBONEAU, JULIA DAWN (CADC R)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:DAWN
Last Name:CHARBONEAU
Suffix:
Gender:F
Credentials:CADC R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 NE 2ND AVE APT 609
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1135
Mailing Address - Country:US
Mailing Address - Phone:503-957-2990
Mailing Address - Fax:
Practice Address - Street 1:211 NE 18TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2822
Practice Address - Country:US
Practice Address - Phone:971-248-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)