Provider Demographics
NPI:1912228719
Name:MOLINE, ERIN C (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:C
Last Name:MOLINE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 SW 6TH AVE
Mailing Address - Street 2:SUITE 801
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1533
Mailing Address - Country:US
Mailing Address - Phone:503-241-6505
Mailing Address - Fax:
Practice Address - Street 1:506 SW 6TH AVE
Practice Address - Street 2:SUITE 801
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1533
Practice Address - Country:US
Practice Address - Phone:503-241-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional