Provider Demographics
NPI:1407420110
Name:DE LA LLAMA, VICTORIA ALYSSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ALYSSE
Last Name:DE LA LLAMA
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 1:2014 SE 12TH AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5380
Mailing Address - Country:US
Mailing Address - Phone:318-754-5009
Mailing Address - Fax:
Practice Address - Street 1:3990 COLLINS WAY STE 202
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3459
Practice Address - Country:US
Practice Address - Phone:503-675-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL85861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty