Provider Demographics
NPI:1811374846
Name:LARSEN DE GISLER, ADRIANA ELIZABETH (SOCIAL WORKER, CADCI)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:ELIZABETH
Last Name:LARSEN DE GISLER
Suffix:
Gender:F
Credentials:SOCIAL WORKER, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 GRAND RONDE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RONDE
Mailing Address - State:OR
Mailing Address - Zip Code:97347-9712
Mailing Address - Country:US
Mailing Address - Phone:503-879-2060
Mailing Address - Fax:503-879-2071
Practice Address - Street 1:4422 NE DEVILS LAKE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-5000
Practice Address - Country:US
Practice Address - Phone:541-265-4947
Practice Address - Fax:541-994-0261
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCADC CANDIDATE101YA0400X
ORT-16-275101YA0400X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)