Provider Demographics
NPI:1760779912
Name:CLEARY, CHARLENE A (CDCS)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:A
Last Name:CLEARY
Suffix:
Gender:F
Credentials:CDCS
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 83
Mailing Address - Street 2:
Mailing Address - City:TOK
Mailing Address - State:AK
Mailing Address - Zip Code:99780-0083
Mailing Address - Country:US
Mailing Address - Phone:907-883-5185
Mailing Address - Fax:907-459-3925
Practice Address - Street 1:MILE 123 TOK CUT OFF
Practice Address - Street 2:
Practice Address - City:TOK
Practice Address - State:AK
Practice Address - Zip Code:99780-0083
Practice Address - Country:US
Practice Address - Phone:907-883-5185
Practice Address - Fax:907-459-3925
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1263101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)