Organization
DIVERGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONIKA K WEITZEL LCSW (FOUNDER/CO-DIRECTOR)
(503) 780-9243
Entity
Organization
Contact information
Practice address
555 SE MLK BLVD, PORTLAND, OR 97214-2526
(503) 780-9243
Mailing address
2000 NE 42ND AVE, PORTLAND, OR 97213-1399
(503) 780-9243
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
10/21/2025
Last updated
10/21/2025
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