Healthcare Provider Details

I. General information

NPI: 1871835090
Provider Name (Legal Business Name): LINDA MARIE PAOLUCCIO LPC, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 FILBERT ST
FOREST GROVE OR
97116-2532
US

IV. Provider business mailing address

PO BOX 1787
MEDFORD OR
97501-0261
US

V. Phone/Fax

Practice location:
  • Phone: 541-500-8655
  • Fax: 800-433-1396
Mailing address:
  • Phone: 541-500-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC4218
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: