Provider Demographics
NPI:1689016701
Name:ALLISON-DAMITZ, LARK MARIE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LARK
Middle Name:MARIE
Last Name:ALLISON-DAMITZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LARK
Other - Middle Name:MARIE
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:702 NE 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7535
Mailing Address - Country:US
Mailing Address - Phone:503-702-6023
Mailing Address - Fax:
Practice Address - Street 1:2875 NW STUCKI AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5806
Practice Address - Country:US
Practice Address - Phone:971-310-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORA40601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program