Provider Demographics
NPI:1912304734
Name:HANSET, CHARLES ALLEN SR (CRM II)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALLEN
Last Name:HANSET
Suffix:SR
Gender:M
Credentials:CRM II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BROADWAY ST STE 130
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3319
Mailing Address - Country:US
Mailing Address - Phone:503-901-7471
Mailing Address - Fax:
Practice Address - Street 1:1101 BROADWAY ST STE 130
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3319
Practice Address - Country:US
Practice Address - Phone:503-901-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X - PEER175T00000X
OR12-CRM-070324500000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR175T00000XOther: 175T00000X PEER SPECIALIST