Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 18-CRM-347 | OR |
NPI | 1003450248 |
---|---|
Provider Name | Amber C Lewis |
First Address | Portland, OR 97205-1715 |
Second Address | Portland, OR 97201-6025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2019 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500772719 | (05) | OR |