Individual
SAMANTHA RAE BLAZIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
847 NE 19TH AVE, PORTLAND, OR 97232-2684
(503) 238-0769
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
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
C5014
OR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/12/2014
Last updated
09/19/2018
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