Provider Demographics
NPI:1487823852
Name:WINNIE, LELIA TRENEE
Entity type:Individual
Prefix:
First Name:LELIA
Middle Name:TRENEE
Last Name:WINNIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LELIA
Other - Middle Name:
Other - Last Name:COTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3034 NE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3053
Mailing Address - Country:US
Mailing Address - Phone:503-283-3763
Mailing Address - Fax:
Practice Address - Street 1:3034 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3053
Practice Address - Country:US
Practice Address - Phone:503-283-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator