Most Relevant Information
Provider Data
| NPI Number: | 1003260571 |
| Provider Name: | DESIREE DAWN STANG LPC INTERN, CADC I |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/20/2016 |
| Last Updated: | 01/27/2019 |
Provider Practice Location
2545 NE FLANDERS ST
PORTLAND
OR
972323139
Practice Location Phone/Fax
| Phone: | 5032353546 |
| Fax: |
Provider Mailing Location
2545 NE FLANDERS ST
PORTLAND
OR
972323139
Provider Mailing Phone/Fax
| Phone: | 5032353546 |
| Fax: |