Individual
ADOLFO JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW/CADC-R
Contact information
Practice address
209 SW 4TH AVE STE 520, PORTLAND, OR 97204-1825
(503) 988-8291
Mailing address
4535 NE 112TH AVE, PORTLAND, OR 97220-2445
(503) 988-5887
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-22-1890
OR
101YM0800X
Mental Health Counselor
22-QMHP-R-1481
OR
104100000X
Social Worker
A13640
OR
1041C0700X
Clinical Social Worker
Primary
L17653
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500809625
—
OR
Enumeration date
08/03/2022
Last updated
07/28/2026
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