Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 02 07 45 | OR |
Y | 1041C0700X | Clinical Social Worker | L2986 | OR |
NPI | 1003974395 |
---|---|
Provider Name | James M Patterson |
First Address | Hood River, OR 97031-0688 |
Second Address | The Dalles, OR 97058-1796 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 06/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02 07 45 | (05) | OR |
139670 | (05) | OR |