Provider Demographics
NPI:1053050310
Name:CHARBONEAU, ANNA STASIA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:STASIA
Last Name:CHARBONEAU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 OAK RIDGE WAY E APT 5
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2946
Mailing Address - Country:US
Mailing Address - Phone:701-893-8068
Mailing Address - Fax:701-425-0419
Practice Address - Street 1:509 OAK RIDGE WAY E APT 5
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2946
Practice Address - Country:US
Practice Address - Phone:701-893-8068
Practice Address - Fax:701-425-0419
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker