Individual
MS. NIKKI LAINE GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4310 NE KILLINGSWORTH ST, PORTLAND, OR 97218-1404
(503) 535-1181
Mailing address
PO BOX 3007, PORTLAND, OR 97208-3007
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
Other
Enumeration date
01/09/2020
Last updated
01/09/2020
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