Provider Demographics
NPI:1801788054
Name:GODDESS ATHENA ACUPUNCTURE AND HOLISTIC HEALING
Entity type:Organization
Organization Name:GODDESS ATHENA ACUPUNCTURE AND HOLISTIC HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HINNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-912-5646
Mailing Address - Street 1:5151 SE HOLGATE BLVD APT 408
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3887
Mailing Address - Country:US
Mailing Address - Phone:541-912-5646
Mailing Address - Fax:
Practice Address - Street 1:6638 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-5250
Practice Address - Country:US
Practice Address - Phone:541-912-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center