Healthcare Provider Details

I. General information

NPI: 1730607854
Provider Name (Legal Business Name): DRAGONFLY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 6TH ST
CLARKSTON WA
99403-2079
US

IV. Provider business mailing address

PO BOX 2031
CLARKSTON WA
99403-4031
US

V. Phone/Fax

Practice location:
  • Phone: 509-254-5053
  • Fax: 509-769-3500
Mailing address:
  • Phone: 509-254-5053
  • Fax: 509-769-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60737830
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANDREA L CHARLES
Title or Position: OWNER/CLINICIAN
Credential: LICSW
Phone: 509-254-5053