Provider Demographics
NPI:1477852135
Name:VINSON, CHARLES D
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:VINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 S COAST HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97366-9667
Mailing Address - Country:US
Mailing Address - Phone:541-265-4190
Mailing Address - Fax:541-574-6252
Practice Address - Street 1:4909 S COAST HWY STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH BEACH
Practice Address - State:OR
Practice Address - Zip Code:97366-9667
Practice Address - Country:US
Practice Address - Phone:541-265-4190
Practice Address - Fax:541-574-6252
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health