Individual
MELISSA ANN CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHA, CNA
Contact information
Practice address
30 NE MLK BLVD, PORTLAND, OR 97232-2941
(503) 232-1099
(503) 232-3854
Mailing address
30 NE MLK BLVD, PORTLAND, OR 97232-2941
(503) 232-1099
(503) 232-3854
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
25-QMHA-R-8013
OR
Other
Enumeration date
01/12/2026
Last updated
01/12/2026
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