Organization
SOVALTI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMISHA K WILSON LCSW (CLINICAL DIRECTOR)
(971) 279-7439
Entity
Organization
Contact information
Practice address
12505 NE HALSEY ST, PORTLAND, OR 97230-1928
(971) 279-7439
(503) 774-4167
Mailing address
PO BOX 12765, PORTLAND, OR 97212-0765
(503) 774-4167
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
03/04/2019
Last updated
04/15/2020
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