Individual
LORI JILL CHARBONNEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
2401 46TH AVE SE STE 201, MANDAN, ND 58554-4829
(701) 699-4052
(701) 989-7030
Mailing address
3425 HEARTWOOD CIR SE, MANDAN, ND 58554-6245
(701) 871-0490
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1526
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024385
BLUE CROSS BLUE SHIELD
ND
05
—
054517
—
ND
Enumeration date
10/09/2007
Last updated
09/12/2022
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