Provider Demographics
NPI:1255881306
Name:DUE, DELAINE KATHRYN (MA, ATR-BC, LPC)
Entity type:Individual
Prefix:
First Name:DELAINE
Middle Name:KATHRYN
Last Name:DUE
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0031
Mailing Address - Country:US
Mailing Address - Phone:541-499-5214
Mailing Address - Fax:
Practice Address - Street 1:459 WILLOW ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1133
Practice Address - Country:US
Practice Address - Phone:541-499-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4275101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health