Provider Demographics
NPI:1780211359
Name:SOARES, LINA (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:SOARES
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 SW BROOKLANE DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1627
Mailing Address - Country:US
Mailing Address - Phone:541-230-8497
Mailing Address - Fax:
Practice Address - Street 1:636 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4442
Practice Address - Country:US
Practice Address - Phone:541-230-8497
Practice Address - Fax:541-600-3330
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL80511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical