Provider Demographics
NPI:1841506961
Name:CHURCH, ANNE C (MA,LPC,CADC II)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:C
Last Name:CHURCH
Suffix:
Gender:F
Credentials:MA,LPC,CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 ESTHER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-9529
Mailing Address - Country:US
Mailing Address - Phone:651-213-4286
Mailing Address - Fax:
Practice Address - Street 1:1901 ESTHER ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-9529
Practice Address - Country:US
Practice Address - Phone:651-213-4286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1213101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)