Provider Demographics
NPI:1851689368
Name:WORKMAN-PURVINE, J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:J
Middle Name:
Last Name:WORKMAN-PURVINE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7334 N CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4869
Mailing Address - Country:US
Mailing Address - Phone:503-201-1614
Mailing Address - Fax:
Practice Address - Street 1:7334 N CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4869
Practice Address - Country:US
Practice Address - Phone:503-928-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL51701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical