Provider Demographics
NPI:1386782530
Name:POWELL, LAURA LEE (CADC II)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEE
Last Name:POWELL
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18345 NE GLISAN ST UNIT 11
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-7273
Mailing Address - Country:US
Mailing Address - Phone:503-669-0169
Mailing Address - Fax:
Practice Address - Street 1:5139 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4403
Practice Address - Country:US
Practice Address - Phone:503-285-9871
Practice Address - Fax:503-978-8640
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)