Individual
LISA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3550 N INTERSTATE AVE, PORTLAND, OR 97227-1196
(503) 331-6374
(503) 249-3447
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
104100000X
Social Worker
4514
OR
1041C0700X
Clinical Social Worker
Primary
L4514
OR
Other
Enumeration date
05/12/2010
Last updated
03/10/2022
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