Individual
SECRET ANN JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC I/CRM/PSS/QMHAR
Contact information
Practice address
1631 SW COUMBIA ST, PORTLAND, OR 97201
(503) 231-2641
(503) 231-1654
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
22-CRM-891
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
23-01-10621
OR
101YM0800X
Mental Health Counselor
23-QMHA-R-3855
OR
175T00000X
Peer Specialist
THW000106531
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500813291
—
OR
Enumeration date
09/28/2021
Last updated
07/17/2023
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