Provider Demographics
NPI:1962675157
Name:CACAO, MARIE CECILIA DOMINIQUE (MA MFT)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:CECILIA DOMINIQUE
Last Name:CACAO
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:CECILIA DOMINIQUE
Other - Last Name:VON WALTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA MFT
Mailing Address - Street 1:1002 LIBRARY CT
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4066
Mailing Address - Country:US
Mailing Address - Phone:503-655-8264
Mailing Address - Fax:503-655-8428
Practice Address - Street 1:1002 LIBRARY CT
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4066
Practice Address - Country:US
Practice Address - Phone:503-655-8264
Practice Address - Fax:503-655-8428
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
OR110366U101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist