Individual
AJNA RAE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3550 N INTERSTATE AVE, PORTLAND, OR 97227-1196
(855) 632-8280
Mailing address
4659 NE AINSWORTH ST, PORTLAND, OR 97218-1849
(503) 318-5590
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/14/2020
Last updated
09/14/2020
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