Healthcare Provider Details

I. General information

NPI: 1427113703
Provider Name (Legal Business Name): CHARLES POLLITT DRAKE LAC LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 10/26/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 23 ST S
FARGO ND
58103
US

IV. Provider business mailing address

1202 23 ST S
FARGO ND
58103
US

V. Phone/Fax

Practice location:
  • Phone: 701-293-5429
  • Fax: 701-293-0736
Mailing address:
  • Phone: 701-293-5429
  • Fax: 701-293-0736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: