Provider Demographics
NPI:1689797664
Name:CHARLIE, DONALD ESAU (CDC II,BHA II)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:ESAU
Last Name:CHARLIE
Suffix:
Gender:M
Credentials:CDC II,BHA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:NENANA
Mailing Address - State:AK
Mailing Address - Zip Code:99760-0253
Mailing Address - Country:US
Mailing Address - Phone:907-832-5467
Mailing Address - Fax:907-832-5477
Practice Address - Street 1:1408 19TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-459-3800
Practice Address - Fax:907-832-5477
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1850101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor