Healthcare Provider Details

I. General information

NPI: 1073264537
Provider Name (Legal Business Name): NORTH COAST CONNECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2022
Last Update Date: 07/18/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 MARINE DR
ASTORIA OR
97103-3808
US

IV. Provider business mailing address

1406 MARINE DR
ASTORIA OR
97103-3808
US

V. Phone/Fax

Practice location:
  • Phone: 503-218-3771
  • Fax:
Mailing address:
  • Phone: 503-218-3771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MELISSA KATHERINE ADAMS
Title or Position: OWNER
Credential:
Phone: 971-235-0917