Provider Demographics
NPI:1437363595
Name:FLORES, CHARLES I (PHD, LPCC, LAADC-S)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:I
Last Name:FLORES
Suffix:
Gender:M
Credentials:PHD, LPCC, LAADC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 PIEDMONT AVE OFC 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4713
Mailing Address - Country:US
Mailing Address - Phone:415-992-8260
Mailing Address - Fax:
Practice Address - Street 1:4000 BROADWAY
Practice Address - Street 2:SUITE 4
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5670
Practice Address - Country:US
Practice Address - Phone:415-992-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional