Provider Demographics
NPI:1982169934
Name:DREWER-TABACCHI, MONICA ELAINE (LPC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ELAINE
Last Name:DREWER-TABACCHI
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 1:6214 SE IVON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1357
Mailing Address - Country:US
Mailing Address - Phone:503-467-8398
Mailing Address - Fax:
Practice Address - Street 1:4431 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-6271
Practice Address - Country:US
Practice Address - Phone:503-467-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional