Individual
SHELISE EBONY HAKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3550 SE WOODWARD ST, PORTLAND, OR 97202-1552
(503) 517-8663
Mailing address
3550 SE WOODWARD ST, PORTLAND, OR 97202-1552
(503) 517-8663
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L4135
OR
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
06/03/2010
Last updated
06/03/2010
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