Individual
KAI L NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC II
Contact information
Practice address
1631 SW COLUMBIA ST, PORTLAND, OR 97201-6025
(503) 231-2641
(503) 231-1654
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(971) 386-2278
(503) 224-4494
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11-12-89
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500694478
—
OR
Enumeration date
10/05/2010
Last updated
08/15/2016
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