Provider Demographics
NPI:1386848364
Name:CHRISTENSEN, CAROL STIMPSON (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:STIMPSON
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 NW UPSUR ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-222-1620
Mailing Address - Fax:503-295-0505
Practice Address - Street 1:2520 NW UPSHUR ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-222-1620
Practice Address - Fax:503-295-0505
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL18151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical