MEDICARE: CARLA CHARLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW61550341	WA
2	1041C0700X	Clinical Social Worker	5771688	ID
3	1041C0700X	Clinical Social Worker	118403	TX

General Provider Information

NPI Number	:	1790436020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA CHARLES

Provider Business Mailing Address
First Line	:	3850 KITSAP WAY STE 104
Second Line	:
City	:	BREMERTON
State	:	WA
Zip	:	98312-2463
Country	:	US
Telephone Number	:	360-209-4336
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 KITSAP WAY STE 104
Second Line	:
City	:	BREMERTON
State	:	WA
Zip	:	98312-2463
Country	:	US
Telephone Number	:	360-209-4336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	06/12/2026

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Directions to “ CARLA CHARLES ” Practice Location

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