Provider Demographics
NPI:1083392286
Name:STEWART-MENDOZA, RAQUEL ALICIA (MA, LPCA)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ALICIA
Last Name:STEWART-MENDOZA
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPCA
Mailing Address - Street 1:12431 SE CARUTHERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12636 SE STARK ST BLDG J
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1058
Practice Address - Country:US
Practice Address - Phone:503-253-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8472101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor