Individual
CHARLES ANNICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSS/CRM
Contact information
Practice address
1310 SW 17TH AVE, PORTLAND, OR 97201-2522
(503) 231-2641
(503) 467-4077
Mailing address
211 SE CARUTHERS ST, PORTLAND, OR 97214-4502
(503) 224-1044
(971) 260-0355
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
24-CRM-3669
OR
175T00000X
Peer Specialist
Primary
113891
OR
Other
Enumeration date
07/29/2025
Last updated
07/29/2025
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