Organization · NPI-2

A Little Light Collective, LLC

Clinic/Center, Mental Health (Including Community Mental Health Center) · Portland, OR

NPI number1124851167
StatusActive
Last updated in NPPESJun 3, 2025

Details

NPI
1124851167
Entity type
Organization (NPI-2)
Legal business name
A Little Light Collective, LLC
Organization subpart
No
Enumeration date
Aug 23, 2024
Certification date
Jun 3, 2025
Last updated
Jun 3, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes
1041C0700X Social Worker, Clinical––

Other names

  • Jordan Dobrovolny Lcsw (Other Name)

Practice location

4605 Ne Fremont St Ste 210f
Portland, OR 97213-1707

Phone 503-994-6702

Mailing address

1717 Ne 42nd Ave Ste 3200
Portland, OR 97213-1572

Phone 503-994-6702

Authorized official

Jordan Mae Dobrovolny
Member
5039946702

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