Individual
DR. GREGORY J. CHARBONEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
EDD, BCN, BCB
Contact information
Practice address
3157 E. 17TH AVENUE, SPOKANE, WA 99223-5136
(509) 838-8066
(800) 594-8305
Mailing address
3157 E. 17TH AVENUE, SPOKANE, WA 99223-5136
(509) 838-8066
(800) 594-8305
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
WA.LIC2046
WA
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
2046
WA
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TH0004X
Health Psychologist
—
—
103TH0100X
Health Service Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80159590
APA#
—
Enumeration date
10/07/2005
Last updated
11/14/2012
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