Individual
JOHN MICHAEL FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHA, CADC1
Contact information
Practice address
1 SERENITY LN, COBURG, OR 97408-9350
(541) 687-1110
Mailing address
1 SERENITY LN, COBURG, OR 97408-9350
(541) 687-1110
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15-05-09
OR
Other
Enumeration date
07/19/2019
Last updated
12/12/2022
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