Provider Demographics
NPI:1922657832
Name:HAEFNER, CHARLOTTE MARIA (MA)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARIA
Last Name:HAEFNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4728 SE HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3242
Mailing Address - Country:US
Mailing Address - Phone:503-683-1009
Mailing Address - Fax:
Practice Address - Street 1:7319 N JOHN AVE STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4890
Practice Address - Country:US
Practice Address - Phone:503-683-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health