Individual
CHARLENE RAE SAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
1 COLVILLE ST, NESPELEM, WA 99155-0150
(509) 634-2727
Mailing address
1 COLVILLE ST, NESPELEM, WA 99155-0150
(509) 634-2727
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP00001142
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992957
—
WA
Enumeration date
05/09/2007
Last updated
07/08/2007
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