Individual
LAURIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
1122 NE 122ND AVE STE A102, PORTLAND, OR 97230-2082
(855) 237-9882
Mailing address
11400 SE 90TH AVE APT 1424, HAPPY VALLEY, OR 97086-2626
(503) 607-5791
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/14/2020
Last updated
12/29/2021
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