Provider Demographics
NPI:1326488545
Name:VEGA, THELMA SOFIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:THELMA
Middle Name:SOFIA
Last Name:VEGA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:THELMA
Other - Middle Name:
Other - Last Name:VEGA LLC
Other - Suffix:VI
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1931 SE MARION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7353
Mailing Address - Country:US
Mailing Address - Phone:503-888-3679
Mailing Address - Fax:888-977-1872
Practice Address - Street 1:6124 SE MILWAUKIE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5347
Practice Address - Country:US
Practice Address - Phone:503-888-3679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2834101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty