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Individual

MANDY CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1030 NE COUCH ST., PORTLAND, OR 97232
(503) 239-8400
(503) 239-8407
Mailing address
1027 E. BURNSIDE ST., PORTLAND, OR 97214
(503) 239-8400
(503) 269-8407

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101YM0800X
Mental Health Counselor

Other

Enumeration date
07/02/2007
Last updated
02/20/2015
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