Provider Demographics
NPI:1417144262
Name:O'CONNELL, ALYCIA A (LCSW, CADC III, CSSW)
Entity Type:Individual
Prefix:
First Name:ALYCIA
Middle Name:A
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:LCSW, CADC III, CSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16469 SE JASPER DR
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-9129
Mailing Address - Country:US
Mailing Address - Phone:503-933-6274
Mailing Address - Fax:503-905-8423
Practice Address - Street 1:107 E HISTORIC COLUMBIA RIVER HWY STE 209
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-2093
Practice Address - Country:US
Practice Address - Phone:503-933-6274
Practice Address - Fax:503-905-8423
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ORL49611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor