Individual
ANDREA L CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
920 6TH ST, CLARKSTON, WA 99403-2079
(509) 254-5053
(509) 769-3500
Mailing address
PO BOX 2031, CLARKSTON, WA 99403-4031
(509) 254-5053
(509) 769-3500
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
LCSW35066
ID
1041C0700X
Clinical Social Worker
Primary
LW60737830
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW - 35066
LICENSE
ID
01
—
LW60737830
LICENSE
WA
Enumeration date
06/29/2013
Last updated
06/14/2023
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