Individual
WYMAN MACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
605 SE CESAR E CHAVEZ BLVD, PORTLAND, OR 97214-3216
(503) 231-7480
Mailing address
605 SE CESAR E CHAVEZ BLVD, PORTLAND, OR 97214-3216
(503) 231-7480
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
03/21/2022
Last updated
11/29/2023
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