Provider Demographics
NPI:1356489736
Name:HENDRICKS, DONLEEN M (LPC, CGACII)
Entity Type:Individual
Prefix:MS
First Name:DONLEEN
Middle Name:M
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:LPC, CGACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7532 SW BARNES RD
Mailing Address - Street 2:#D
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6235
Mailing Address - Country:US
Mailing Address - Phone:503-313-5372
Mailing Address - Fax:
Practice Address - Street 1:847 NE 19TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2684
Practice Address - Country:US
Practice Address - Phone:503-963-2577
Practice Address - Fax:503-239-5953
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
ORCGAC II101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101YA0400XOtherCGACII