Individual
MIKE C THEODORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHA
Contact information
Practice address
17933 NW EVERGREEN PKWY STE 111, BEAVERTON, OR 97006-7452
(814) 243-0414
(814) 479-5906
Mailing address
3159 CARPENTERS PARK RD, DAVIDSVILLE, PA 15928-9223
(814) 243-0414
(814) 479-5906
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
35007
NY
Other
Enumeration date
02/15/2023
Last updated
02/15/2023
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