Provider Demographics
NPI:1649911926
Name:MCCUNE, CHARLENE M (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:M
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:MSW, LICSW
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 1237
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-0975
Mailing Address - Country:US
Mailing Address - Phone:253-961-0099
Mailing Address - Fax:
Practice Address - Street 1:1476 OLNEY AVE SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4041
Practice Address - Country:US
Practice Address - Phone:253-961-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-02
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608772541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical