Individual
MISS MIYA GRAY ABBOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICENSED CLINICAL SO
Contact information
Practice address
2304 E. BUMSIDE ST., SUITE 201, PORTLAND, OR 97214
(503) 951-0328
Mailing address
2304 E BURNSIDE ST STE 201, PORTLAND, OR 97214-1689
(503) 951-0328
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L4914
OR
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500637536
—
OR
Enumeration date
12/17/2007
Last updated
10/23/2023
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