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General NPI Number Information
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NPI Number | 1881863058
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Entity Type | Individual
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Provider Name | CHARLES ALLEN TALLEY CADC II ,A6060611
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Gender | Male
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 1211 PUERTA DEL SOL STE 280
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6362
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Country | US
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Telephone | 949-276-5553
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Fax | 949-498-2619
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Provider Business Mailing Address
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Address Line | 1211 PUERTA DEL SOL STE 280
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6362
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Country | US
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Telephone | 949-276-5553
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Fax | 949-498-2619
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CADCII; A6060611
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License Number State | CA
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