Individual
MRS. LISA MARIE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
412 SW 12TH AVE, PORTLAND, OR 97205-2329
(503) 552-5105
Mailing address
7028 N MOBILE AVE, PORTLAND, OR 97217-5744
(503) 552-5105
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/29/2007
Last updated
07/08/2007
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