Individual
NICOLE CONNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC1 QMHA-R
Contact information
Practice address
306 SW 8TH ST, CORVALLIS, OR 97333-4543
(541) 753-2230
Mailing address
306 SW 8TH ST, CORVALLIS, OR 97333-4543
(541) 753-2230
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
Other
Enumeration date
10/25/2022
Last updated
11/21/2023
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