Provider Demographics
NPI:1093432957
Name:SOCIAL 58 LLC
Entity type:Organization
Organization Name:SOCIAL 58 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, LPC, NCC
Authorized Official - Phone:503-836-3104
Mailing Address - Street 1:1515 SW 5TH AVE STE 930
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5406
Mailing Address - Country:US
Mailing Address - Phone:503-836-3104
Mailing Address - Fax:
Practice Address - Street 1:1515 SW 5TH AVE STE 930
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5406
Practice Address - Country:US
Practice Address - Phone:503-836-3104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty