Provider Demographics
NPI:1811142789
Name:GARCIA, DEBRA OLESEN (MSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:OLESEN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 SE 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3216
Mailing Address - Country:US
Mailing Address - Phone:503-731-9536
Mailing Address - Fax:503-731-9574
Practice Address - Street 1:605 SE 39TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3216
Practice Address - Country:US
Practice Address - Phone:503-731-9536
Practice Address - Fax:503-731-9574
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA16341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical