Individual
CHARLEY LD THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDPT, CAAR
Contact information
Practice address
21 COLVILLE ST, NESPELEM, WA 99155-0150
(509) 634-2610
Mailing address
PO BOX 150, NESPELEM, WA 99155-0150
(509) 634-2610
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CG61246795
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61248358
WA
Other
Enumeration date
09/02/2022
Last updated
09/13/2022
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