Provider Demographics
NPI:1174120141
Name:DILLINGHAM, SOPHIA R (LPC)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:R
Last Name:DILLINGHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:R
Other - Last Name:SHORTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA QMHP-R
Mailing Address - Street 1:4105 SE INTERNATIONAL WAY STE 505
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-8855
Mailing Address - Country:US
Mailing Address - Phone:503-258-4545
Mailing Address - Fax:
Practice Address - Street 1:4105 SE INTERNATIONAL WAY STE 505
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-8855
Practice Address - Country:US
Practice Address - Phone:503-258-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR128715Medicaid