Provider Demographics
NPI:1942223367
Name:CORBIN LAWSON, NICOLE (QMHP,LPC,CADC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:CORBIN LAWSON
Suffix:
Gender:F
Credentials:QMHP,LPC,CADC
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:CORBIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:QMHP,LPC,CADC
Mailing Address - Street 1:PO BOX 8459
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-8459
Mailing Address - Country:US
Mailing Address - Phone:503-957-4936
Mailing Address - Fax:
Practice Address - Street 1:2415 SE 43RD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1600
Practice Address - Country:US
Practice Address - Phone:503-872-0151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR02-11-23101YA0400X
101YM0800X
ORC1230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health