Provider Demographics
NPI:1306413984
Name:WATERS, ALLISON (MSW, MDIV, QMHP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:MSW, MDIV, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3034 NE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3053
Mailing Address - Country:US
Mailing Address - Phone:503-283-3763
Mailing Address - Fax:
Practice Address - Street 1:3034 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3053
Practice Address - Country:US
Practice Address - Phone:503-283-3763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral