Provider Demographics
NPI:1245903665
Name:DANIELSON, ERIN THERESA (LCSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:THERESA
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17727 SE KELLY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1150
Mailing Address - Country:US
Mailing Address - Phone:503-313-7847
Mailing Address - Fax:
Practice Address - Street 1:1505 NE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1911
Practice Address - Country:US
Practice Address - Phone:503-313-7847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL7354101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health