Healthcare Provider Details

I. General information

NPI: 1811374846
Provider Name (Legal Business Name): ADRIANA ELIZABETH LARSEN DE GISLER SOCIAL WORKER, CADCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 NE DEVILS LAKE BLVD STE 2
LINCOLN CITY OR
97367-5000
US

IV. Provider business mailing address

9605 GRAND RONDE RD
GRAND RONDE OR
97347-9712
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-4947
  • Fax: 541-994-0261
Mailing address:
  • Phone: 503-879-2060
  • Fax: 503-879-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC CANDIDATE
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-16-275
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: