Provider Demographics
NPI:1063744175
Name:CHOICES DOMESTIC VIOLENCE INTERVENTION PROGRAM, LLC
Entity type:Organization
Organization Name:CHOICES DOMESTIC VIOLENCE INTERVENTION PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CADCIII
Authorized Official - Phone:503-239-7597
Mailing Address - Street 1:9828 E BURNSIDE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2364
Mailing Address - Country:US
Mailing Address - Phone:503-293-7597
Mailing Address - Fax:503-232-4446
Practice Address - Street 1:9828 E BURNSIDE ST STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2364
Practice Address - Country:US
Practice Address - Phone:503-293-7597
Practice Address - Fax:503-232-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health