Provider Demographics
NPI:1821548728
Name:LARSON-HILLS, VICKIE MARIE (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:MARIE
Last Name:LARSON-HILLS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 NE ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:SUBLIMITY
Mailing Address - State:OR
Mailing Address - Zip Code:97385-9106
Mailing Address - Country:US
Mailing Address - Phone:503-509-6223
Mailing Address - Fax:
Practice Address - Street 1:340 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2738
Practice Address - Country:US
Practice Address - Phone:360-356-2508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORL76371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL7637OtherLICENSED CLINICAL SOCIAL WORKER LICENSE #
OR500717536Medicaid