Provider Demographics
NPI:1386798833
Name:HICE, DONALD JOSEPH (QMHP)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JOSEPH
Last Name:HICE
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NE 61ST AVE APT D7
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3868
Mailing Address - Country:US
Mailing Address - Phone:503-544-5300
Mailing Address - Fax:
Practice Address - Street 1:5120 SE 118TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-3250
Practice Address - Country:US
Practice Address - Phone:503-762-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health