Provider Demographics
NPI:1245783943
Name:DANIEL G STINEA LLC
Entity Type:Organization
Organization Name:DANIEL G STINEA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:STINEA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CADC III
Authorized Official - Phone:503-209-2392
Mailing Address - Street 1:4410 SE WOODSTOCK BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6206
Mailing Address - Country:US
Mailing Address - Phone:503-209-2392
Mailing Address - Fax:503-244-7424
Practice Address - Street 1:3939 NE HANCOCK ST STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5321
Practice Address - Country:US
Practice Address - Phone:503-209-2392
Practice Address - Fax:503-244-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health