Individual
CHARLES DICKERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT, CADC III, SUDP
Contact information
Practice address
19500 SE STARK ST, PORTLAND, OR 97233-5757
(503) 249-3434
Mailing address
19500 SE STARK ST, PORTLAND, OR 97233-5757
(503) 249-3434
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11-06-19
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP60796757
WA
106H00000X
Marriage & Family Therapist
Primary
T0866
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
Enumeration date
04/03/2008
Last updated
12/27/2023
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