Individual provider · Type 1 NPI

Aisha Wallace

Mental Health Counselor · Portland, OR

NPI number 1467580266 Active

Practice location

521 SW 11th Ave
Portland, OR 97205-2634

Mailing address

4425 NE Ainsworth St
Portland, OR 97218-1319

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1467580266

Aisha Wallace's National Provider Identifier is 1467580266, issued on Mar 1, 2007. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Portland, OR. The record was last updated on Jul 8, 2007.