Individual
LLOYD CHRIS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MCM, CADC I, CRM II
Contact information
Practice address
10564 SE WASHINGTON ST, PORTLAND, OR 97216-2809
(503) 228-9229
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
23-05-10745
OR
175T00000X
Peer Specialist
Primary
23-CRM-II-0094
OR
Other
Enumeration date
06/23/2023
Last updated
06/23/2023
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