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NPI Code Detail

MEDICARE: DRAGONFLY COUNSELING PLLC

MEDICARE: DRAGONFLY COUNSELING PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist
21041C0700XClinical Social WorkerLW60737830WA
3101YM0800XMental Health Counselor
41041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11235554668OTHERWAPERSONAL NPI
21396368668OTHERWAPERSONAL NPI
31730529165OTHERPERSONAL NPI

General Provider Information

NPI Number : 1730607854
Entity Type Code : Organization
Provider Name (Legal Business Name) : DRAGONFLY COUNSELING PLLC
Provider Business Mailing Address
First Line : PO BOX 2031
Second Line :
City : CLARKSTON
State : WA
Zip : 99403-4031
Country : US
Telephone Number : 509-254-5053
Fax Number : 509-769-3500
Provider Business Practice Location Address
First Line : 920 6TH ST
Second Line :
City : CLARKSTON
State : WA
Zip : 99403-2079
Country : US
Telephone Number : 509-254-5053
Fax Number : 509-769-3500
Authorized Official
Title or Position : OWNER/CLINICIAN
Name : ANDREA L CHARLES
Credential : LICSW
Telephone Number : 509-254-5053
Provider Enumeration Date : 09/08/2017
Last Update Date : 02/07/2024

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Directions to “DRAGONFLY COUNSELING PLLC ” Practice Location

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