Individual
LUCY ROSE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC II
Contact information
Practice address
17645 NW SAINT HELENS RD, PORTLAND, OR 97231-1729
(503) 621-1069
(503) 621-0200
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
00-03-32
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
11807
ID
Other
Enumeration date
01/03/2012
Last updated
09/10/2024
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