Individual
MOLLY BROWN DOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC, NCC
Contact information
Practice address
2928 SE HAWTHORNE BLVD STE C, PORTLAND, OR 97214-4147
(503) 504-6455
(844) 792-9639
Mailing address
4306 SE ELLIS ST, PORTLAND, OR 97206-5759
(503) 504-6455
(844) 792-9639
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C3108
OR
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210855
—
OR
05
—
500660733
—
OR
Enumeration date
03/07/2008
Last updated
01/28/2021
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