Healthcare Provider Details

I. General information

NPI: 1821375676
Provider Name (Legal Business Name): CELESTE IAN DONEEN LCSW, MAC, CADC III
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6124 SE MILWAUKIE AVE
PORTLAND OR
97202-5347
US

IV. Provider business mailing address

1612 SE MILLER ST
PORTLAND OR
97202-6705
US

V. Phone/Fax

Practice location:
  • Phone: 503-317-1385
  • Fax:
Mailing address:
  • Phone: 503-317-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number08-12-78
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA2523
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: