Individual
DAVIDE JEANETTE COSTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
1345 BIRCH AVE, COTTAGE GROVE, OR 97424
(541) 942-3939
Mailing address
6374 F ST, SPRINGFIELD, OR 97478-7084
(547) 747-1235
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C4859
OR
Other
Enumeration date
09/28/2011
Last updated
05/15/2018
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