Provider Demographics
NPI:1821440173
Name:GILCHRIST-STEWART, ANGELA M (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:GILCHRIST-STEWART
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16005 NW SKYLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97231-2434
Mailing Address - Country:US
Mailing Address - Phone:503-875-6279
Mailing Address - Fax:
Practice Address - Street 1:2190 SE OAK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:OR
Practice Address - Zip Code:97267-2658
Practice Address - Country:US
Practice Address - Phone:503-875-6279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5344101YP2500X
372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult Companion