Individual
CHARLES BLACKMAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
6118 SE BELMONT ST STE 402, PORTLAND, OR 97215-1983
(712) 206-2139
Mailing address
6118 SE BELMONT ST STE 402, PORTLAND, OR 97215-1983
(503) 220-6213
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
L6504
OR
171M00000X
Case Manager/Care Coordinator
—
—
372600000X
Adult Companion
—
—
Other
Enumeration date
07/24/2007
Last updated
09/18/2024
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