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Organization
REACHING IN SERVING KIDS
Active
Organization
REACHING IN SERVING KIDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEONARD N/A CLARK SR. CADC II (DIRECTOR)
(503) 593-7764
Entity
Organization
Contact information
Practice address
4134 N VANCOUVER AVE, SUITE 303C, PORTLAND, OR 97217-2900
(503) 593-7764
(503) 249-2047
Mailing address
4134 N VANCOUVER AVE, SUITE 303C, PORTLAND, OR 97217-2900
(503) 593-7764
(503) 249-2047
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06-R-06
CERTIFIED ALCOHOL AND DRUG COUNSELOR II
OR
Enumeration date
06/05/2012
Last updated
06/05/2012
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