Organization
POTENTIALS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DANA S DEDOLPH MA, LPC (DIRECTOR/THERAPIST)
(503) 325-2398
Entity
Organization
Contact information
Practice address
100 39TH ST PIER 39, ASTORIA, OR 97103-2499
(503) 325-2398
(503) 325-5932
Mailing address
100 39TH ST PIER 39, ASTORIA, OR 97103-2499
(503) 325-2398
(503) 325-5932
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
C1489
OR
Other
Enumeration date
09/21/2007
Last updated
09/21/2007
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