Individual
MICHELLE ANN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADAC-II
Contact information
Practice address
1427 SE 182ND AVE, PORTLAND, OR 97233-5008
(503) 761-6006
(503) 761-1434
Mailing address
1027 E BURNSIDE ST, PORTLAND, OR 97214-1328
(503) 239-8400
(503) 239-8407
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
22-R-34
OR
Other
Enumeration date
10/27/2022
Last updated
10/27/2022
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