Provider Demographics
NPI:1386421626
Name:CHARTER, WILLIAM CODY DANIEL (CADC-R, CRM II)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CODY DANIEL
Last Name:CHARTER
Suffix:
Gender:M
Credentials:CADC-R, CRM II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-2744
Mailing Address - Country:US
Mailing Address - Phone:541-206-5589
Mailing Address - Fax:
Practice Address - Street 1:1333 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1482
Practice Address - Country:US
Practice Address - Phone:541-447-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-CRM-II-0154175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist