Provider Demographics
NPI:1285995332
Name:DION, THERESE (LCSW)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:DION
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:DION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4308 SE ASH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1048
Mailing Address - Country:US
Mailing Address - Phone:503-236-5120
Mailing Address - Fax:
Practice Address - Street 1:4308 SE ASH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1048
Practice Address - Country:US
Practice Address - Phone:503-236-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical