Provider Demographics
NPI:1184007569
Name:CREA VANCE, ANYA GABRIELLE (LPC-C7301)
Entity Type:Individual
Prefix:
First Name:ANYA
Middle Name:GABRIELLE
Last Name:CREA VANCE
Suffix:
Gender:F
Credentials:LPC-C7301
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 NE MARTIN LUTHER KING JR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2093
Mailing Address - Country:US
Mailing Address - Phone:503-327-8205
Mailing Address - Fax:
Practice Address - Street 1:3500 NE MARTIN LUTHER KING JR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2093
Practice Address - Country:US
Practice Address - Phone:503-327-8205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
ORC7301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health