Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 104100000X | Social Worker |
NPI | 1306413984 |
---|---|
Provider Name | Allison Waters |
First Address | Portland, OR 97212-3053 |
Second Address | Portland, OR 97212-3053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2021 |
Last Update Date | 10/06/2021 |