Doctor Name: | DEANNA GOLD |
NPI Number: | 1003013327 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | |
Business Practice Address: | 847 Ne 19th Ave Suite 100 Portland, OR - 972322684 |
Business Phone Number: | 5038919937 |
Business Fax Number: | |
Mailing Address: | 430 Ne 16th Ave, Apt 310 PORTLAND |
State: | OR |
Postal Code: | 972322869 |
Phone Number: | 5038919937 |
Fax Number: | |
NPI Enumeration Date: | 06/29/2007 |
NPI Last Update Date: | 07/10/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |