Individual provider · NPI-1

Miya Gray Abbott, Licensed Clinical So

Social Worker, Clinical · Portland, OR

NPI number1053595785
StatusActive
Last updated in NPPESOct 23, 2023

Details

NPI
1053595785
Entity type
Individual (NPI-1)
Name
Miss Miya Gray Abbott
Credential
Licensed Clinical So
Sex
Female
Sole proprietor
Yes
Enumeration date
Dec 17, 2007
Certification date
Jan 21, 2021
Last updated
Oct 23, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1041C0700X Social Worker, ClinicalL4914ORYes
1041C0700X Social Worker, Clinical––

Practice location

2304 E. Bumside St.
Suite 201
Portland, OR 97214

Phone 503-951-0328

Mailing address

2304 E Burnside St Ste 201
Portland, OR 97214-1689

Phone 503-951-0328

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