Provider Demographics
NPI:1881863058
Name:TALLEY, CHARLES ALLEN (CADC II ,A6060611)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALLEN
Last Name:TALLEY
Suffix:
Gender:M
Credentials:CADC II ,A6060611
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Mailing Address - Street 1:1211 PUERTA DEL SOL STE 280
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6362
Mailing Address - Country:US
Mailing Address - Phone:949-276-5553
Mailing Address - Fax:949-498-2619
Practice Address - Street 1:1211 PUERTA DEL SOL STE 280
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6362
Practice Address - Country:US
Practice Address - Phone:949-276-5553
Practice Address - Fax:949-498-2619
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2014-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CACADCII; A6060611101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)