Provider Demographics
NPI:1538172598
Name:CHARLTON, DARA MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DARA
Middle Name:MICHELLE
Last Name:CHARLTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DARA
Other - Middle Name:MICHELLE
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6308 FROST LN
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4584
Mailing Address - Country:US
Mailing Address - Phone:503-744-0684
Mailing Address - Fax:503-231-8153
Practice Address - Street 1:5125 SW MACADAM AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3820
Practice Address - Country:US
Practice Address - Phone:503-231-7854
Practice Address - Fax:503-231-8153
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL38261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical