Organization
BLKJADE. MENTAL WELLNESS, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROXANNE SHEENA CAPPARELLI LCSW, CADC-R (OWNER / SOLE MEMBER)
(503) 208-8258
Entity
Organization
Contact information
Practice address
2926 NE FLANDERS ST # 3A, PORTLAND, OR 97232-3259
(503) 208-8258
(503) 328-7780
Mailing address
3519 NE 15TH AVE # 294, PORTLAND, OR 97212-2356
(503) 208-8258
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861893232
—
OR
05
—
500822543
—
OR
Enumeration date
08/18/2023
Last updated
10/05/2023
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