Individual
DANIEL RAY COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC 1
Contact information
Practice address
3180 CENTER ST NE, DRUG TREATMENT, SALEM, OR 97301-4592
(503) 576-4660
(503) 361-2688
Mailing address
1641 D ST NE, SALEM, OR 97301-2664
(503) 910-4531
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
08-08-10
OR
Other
Enumeration date
06/07/2010
Last updated
06/07/2010
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