Provider Demographics
NPI:1902449259
Name:EVERS GERDING, DANIELLE RAE (MA, LPC)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:RAE
Last Name:EVERS GERDING
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:GERDING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:5441 S MACADAM AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6106
Mailing Address - Country:US
Mailing Address - Phone:541-704-7721
Mailing Address - Fax:
Practice Address - Street 1:5441 S MACADAM AVE STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6106
Practice Address - Country:US
Practice Address - Phone:541-704-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC9767101YP2500X, 101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health