Healthcare Provider Details

I. General information

NPI: 1912304734
Provider Name (Legal Business Name): CHARLES ALLEN HANSET SR. CRM II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BROADWAY ST STE 130
VANCOUVER WA
98660-3319
US

IV. Provider business mailing address

1101 BROADWAY ST STE 130
VANCOUVER WA
98660-3319
US

V. Phone/Fax

Practice location:
  • Phone: 503-901-7471
  • Fax:
Mailing address:
  • Phone: 503-901-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number12-CRM-070
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number175T00000X - PEER
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: