Individual
FREDERICK DOUGLASS STATEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.,LPC, CADC III
Contact information
Practice address
10920 SW BARBUR BLVD, PORTLAND, OR 97219-8600
(503) 244-4500
(503) 244-2008
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 230-9654
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
C2994
OR
101YP2500X
Professional Counselor
Primary
C4765
OR
101YP2500X
Professional Counselor
LH60296096
WA
Other
Enumeration date
05/07/2012
Last updated
03/13/2026
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