Provider Demographics
NPI:1316565955
Name:RACCUGLIA, OLIVIA (LPC INTERN)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:RACCUGLIA
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 NE FLANDERS ST STE 3C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3259
Mailing Address - Country:US
Mailing Address - Phone:971-270-0167
Mailing Address - Fax:503-967-8328
Practice Address - Street 1:2926 NE FLANDERS ST STE 3C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3259
Practice Address - Country:US
Practice Address - Phone:971-270-0167
Practice Address - Fax:503-967-8328
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health