Healthcare Provider Details

I. General information

NPI: 1962707794
Provider Name (Legal Business Name): DARCELL DANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5329 NE MARTIN LUTHER KING JR BLVD
PORTLAND OR
97211-3237
US

IV. Provider business mailing address

421 SW OAK ST STE. 210
PORTLAND OR
97204-1817
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-5183
  • Fax: 503-988-5182
Mailing address:
  • Phone: 503-988-3663
  • Fax: 503-988-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3553
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: