Provider Demographics
NPI:1699380279
Name:PATRICE, AMELIA DORE (MSW, CSWA)
Entity type:Individual
Prefix:MS
First Name:AMELIA
Middle Name:DORE
Last Name:PATRICE
Suffix:
Gender:F
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:TUZZOLINO
Other - Last Name:WILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, CSWA
Mailing Address - Street 1:1524 GILES AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4730
Mailing Address - Country:US
Mailing Address - Phone:360-451-9954
Mailing Address - Fax:
Practice Address - Street 1:2950 SE STARK ST STE 130
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3082
Practice Address - Country:US
Practice Address - Phone:971-270-0167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA142411041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor