Provider Demographics
NPI:1063281814
Name:FAHEY, DIANA MARIE (CADC-R)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:FAHEY
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 NW DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3925
Mailing Address - Country:US
Mailing Address - Phone:503-226-2203
Mailing Address - Fax:503-223-4231
Practice Address - Street 1:324 NW DAVIS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3925
Practice Address - Country:US
Practice Address - Phone:503-226-2203
Practice Address - Fax:503-223-4231
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-23-3367101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)