Provider Demographics
NPI:1437235900
Name:ROSE, CHRISTINA OPAL (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:OPAL
Last Name:ROSE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:O
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1832 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1992
Mailing Address - Country:US
Mailing Address - Phone:503-282-8600
Mailing Address - Fax:503-287-0967
Practice Address - Street 1:1832 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1992
Practice Address - Country:US
Practice Address - Phone:503-282-8600
Practice Address - Fax:503-287-0967
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1448101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional