Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YS0200X | School Counselor |
NPI | 1154622876 |
---|---|
Provider Name | Carla Jean Herb |
First Address | Portland, OR 97229-5442 |
Second Address | Portland, OR 97229-5442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2010 |
Last Update Date | 17/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
195164 | (05) | OR |