Individual
AUTUMN JONES-BIGBOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC-R/CRM/PSS
Contact information
Practice address
1631 SW COLUMBIA ST, PORTLAND, OR 97201-6025
(503) 231-2641
(503) 231-1654
Mailing address
10564 SE WASHINGTON ST, PORTLAND, OR 97216-2809
(503) 228-9229
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16-CRM-163
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-18-383
OR
175T00000X
Peer Specialist
THW0001464
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500730706
—
OR
05
—
500755072
—
OR
Enumeration date
12/13/2016
Last updated
06/14/2023
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