Individual
CAROLYN WATERFALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCI
Contact information
Practice address
12332 SW 72ND AVE STE 113, PORTLAND, OR 97223-8688
(503) 686-3918
Mailing address
12332 SW 72ND AVE APT 113, PORTLAND, OR 97223-8688
(503) 686-3918
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
R4777
OR
Other
Enumeration date
07/07/2017
Last updated
07/21/2022
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