Provider Demographics
NPI:1558799411
Name:KUJALA, LEA MARIA (LCSW, CADCI)
Entity Type:Individual
Prefix:MRS
First Name:LEA
Middle Name:MARIA
Last Name:KUJALA
Suffix:
Gender:F
Credentials:LCSW, CADCI
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:
Other - Last Name:AVOLIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CADCI
Mailing Address - Street 1:13515 SW ASH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4942
Mailing Address - Country:US
Mailing Address - Phone:503-544-6391
Mailing Address - Fax:
Practice Address - Street 1:706 MAIN ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1815
Practice Address - Country:US
Practice Address - Phone:035-655-1029
Practice Address - Fax:503-655-4705
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR110604101YA0400X
ORL65401041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical