Individual
DONDRAE FAIR SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
3910 SE STARK ST, PORTLAND, OR 97214-3241
(503) 764-7445
Mailing address
3910 SE STARK, PORTLAND, OR 97214
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
14.CRM.008
OR
175T00000X
Peer Specialist
—
—
Other
Enumeration date
09/19/2014
Last updated
10/22/2015
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