Healthcare Provider Details

I. General information

NPI: 1033072921
Provider Name (Legal Business Name): OLIVIA R DENICHOLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5602 SE OAK ST APT 2
PORTLAND OR
97215-1393
US

IV. Provider business mailing address

5602 SE OAK ST
PORTLAND OR
97215-1393
US

V. Phone/Fax

Practice location:
  • Phone: 774-563-9332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: