Provider Demographics
NPI:1316601651
Name:STALIONS, LAURA JEAN (CADC-R)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:STALIONS
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 1:4616 SE 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-4382
Mailing Address - Country:US
Mailing Address - Phone:206-383-7814
Mailing Address - Fax:
Practice Address - Street 1:12670 NW BARNES RD STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-9001
Practice Address - Country:US
Practice Address - Phone:971-272-8968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)