Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003175332 |
---|---|
Provider Name | Evelyn Reese Acopan |
First Address | Portland, OR 97207-8459 |
Second Address | Portland, OR 97220-3873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2012 |
Last Update Date | 04/09/2013 |