Healthcare Provider Details

I. General information

NPI: 1093681223
Provider Name (Legal Business Name): CHARLI MERCEDES WOMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 MARTIN ST # 1
BLAINE WA
98230-4045
US

IV. Provider business mailing address

411 FORTUYN RD
GRAND COULEE WA
99133-8718
US

V. Phone/Fax

Practice location:
  • Phone: 360-788-4228
  • Fax:
Mailing address:
  • Phone: 509-633-1753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: