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Individual

JACKLINE ALSTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
8401 NE HALSEY ST, PORTLAND, OR 97220-5670
(602) 814-4367
Mailing address
8401 NE HALSEY ST, PORTLAND, OR 97220-5670
(602) 814-4367

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
SA0950118
MA
101YM0800X
Mental Health Counselor
Primary
OR
172A00000X
Driver
Primary
SA0950118
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
001385522
STATE
MA
Enumeration date
10/12/2020
Last updated
03/11/2026
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