Provider Demographics
NPI:1235293861
Name:CHRISTENSEN, CAROL CHARLOTTE (CADCIII QMHP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:CHARLOTTE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:CADCIII QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5085 WINDSOR ISLAND RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5750
Mailing Address - Country:US
Mailing Address - Phone:503-393-2782
Mailing Address - Fax:
Practice Address - Street 1:3180 CENTER ST NE RM 2370
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4532
Practice Address - Country:US
Practice Address - Phone:503-585-4912
Practice Address - Fax:503-566-2948
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR99-07-06101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health