Provider Demographics
NPI:1013635382
Name:BABCOCK, CHARLES LEIGH II (SUDP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LEIGH
Last Name:BABCOCK
Suffix:II
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 W SIMS WAY
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2255
Mailing Address - Country:US
Mailing Address - Phone:360-385-1258
Mailing Address - Fax:
Practice Address - Street 1:3051 W SIMS WAY
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2255
Practice Address - Country:US
Practice Address - Phone:360-385-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)