Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YP1600X | Pastoral Counselor | ||
Y | 104100000X | Social Worker |
NPI | 1205012838 |
---|---|
Provider Name | Reginald Timothy Snow |
First Address | Portland, OR 97206-7564 |
Second Address | Portland, OR 97206-7564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 01/07/2009 |