Provider Demographics
NPI:1194069187
Name:THE CHARIS CLINIC PLLC
Entity type:Organization
Organization Name:THE CHARIS CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER, LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:DEONNE
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:BENEDICT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-714-4476
Mailing Address - Street 1:23601 HIGHWAY 99 STE A
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-9212
Mailing Address - Country:US
Mailing Address - Phone:206-714-4476
Mailing Address - Fax:425-732-4476
Practice Address - Street 1:23601 HIGHWAY 99 STE A
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9212
Practice Address - Country:US
Practice Address - Phone:206-714-4476
Practice Address - Fax:425-732-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602904773261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care