Individual
CHARLES LUKE ENOMOTO SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20 LAKE BLVD, REDDING, CA 96003-2512
(530) 229-1416
Mailing address
12591 SHALON DR, REDDING, CA 96003-0382
(530) 510-3149
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
A057340620
CA
101YP1600X
Pastoral Counselor
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912215492
TRI-WEST
CA
Enumeration date
04/18/2022
Last updated
04/18/2022
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