Individual
CHARLES SEVIDZEM FAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
412 SW 12TH AVE, PORTLAND, OR 97205-2329
(503) 228-7134
(503) 944-2595
Mailing address
8325 SW 37TH AVE, PORTLAND, OR 97219-3608
(503) 452-0754
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/08/2007
Last updated
11/01/2010
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