Provider Demographics
NPI:1700948361
Name:DECINA, ANNALISA J (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANNALISA
Middle Name:J
Last Name:DECINA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 W OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3720
Mailing Address - Country:US
Mailing Address - Phone:541-264-6017
Mailing Address - Fax:
Practice Address - Street 1:1061 NE AVERY ST
Practice Address - Street 2:STE B
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3038
Practice Address - Country:US
Practice Address - Phone:541-264-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2553101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500673832Medicaid