Provider Demographics
NPI:1346546298
Name:OLSEN, VICTORIA DIANNE (CADC I)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:DIANNE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9828 E BURNSIDE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2364
Mailing Address - Country:US
Mailing Address - Phone:503-239-7597
Mailing Address - Fax:
Practice Address - Street 1:9828 E BURNSIDE ST STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2364
Practice Address - Country:US
Practice Address - Phone:503-239-7597
Practice Address - Fax:503-232-4446
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00-07-52101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)