Healthcare Provider Details

I. General information

NPI: 1669860383
Provider Name (Legal Business Name): JANICE CONSTANTINO LPC, CADC 1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANICE MALLARI VICEDO

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 SW MERLO DR
BEAVERTON OR
97003-5013
US

IV. Provider business mailing address

7320 SW HUNZIKER RD STE 300
PORTLAND OR
97223-2302
US

V. Phone/Fax

Practice location:
  • Phone: 503-941-3210
  • Fax:
Mailing address:
  • Phone: 503-941-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5387
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: