Individual
D'VORAH BROCKMAN MAYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHP, LPC, NCC
Contact information
Practice address
847 NE 19TH AVE STE 100, PORTLAND, OR 97232-2684
(503) 238-0769
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
C7718
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C7718
LPC REGISTRATION NUMBER
OR
Enumeration date
07/16/2016
Last updated
10/02/2023
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