Provider Demographics
NPI:1275877250
Name:OGAWA, AZUSA (LPC, CGACII, CADCI)
Entity Type:Individual
Prefix:MS
First Name:AZUSA
Middle Name:
Last Name:OGAWA
Suffix:
Gender:F
Credentials:LPC, CGACII, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 NE DEVILS LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-5000
Mailing Address - Country:US
Mailing Address - Phone:541-265-4179
Mailing Address - Fax:541-574-6252
Practice Address - Street 1:51 SW LEE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365
Practice Address - Country:US
Practice Address - Phone:541-574-5960
Practice Address - Fax:541-265-0601
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCGACI: G13-04-06101YA0400X
ORCADCI: 14-05-07101YA0400X
ORC4730101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)