Provider Demographics
NPI:1710649793
Name:CHARLES, PAX (MSW, LSWAIC)
Entity Type:Individual
Prefix:
First Name:PAX
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 NW 125TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2029
Mailing Address - Country:US
Mailing Address - Phone:360-433-7047
Mailing Address - Fax:
Practice Address - Street 1:9120 NE VANCOUVER MALL DRIVE
Practice Address - Street 2:STE #160
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-9401
Practice Address - Country:US
Practice Address - Phone:360-891-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program