Provider Demographics
NPI:1013054501
Name:CHARLES, ROBERTA L (ME, CAS,LMHC)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:L
Last Name:CHARLES
Suffix:
Gender:F
Credentials:ME, CAS,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-2724
Mailing Address - Country:US
Mailing Address - Phone:360-460-5963
Mailing Address - Fax:
Practice Address - Street 1:407 CHARLES RD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-2724
Practice Address - Country:US
Practice Address - Phone:360-460-5963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006602101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health