Individual
NICOLE RENEE TRIPLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC II
Contact information
Practice address
3878 BEVERLY AVE NE STE 5, SALEM, OR 97305-1335
(503) 363-2021
Mailing address
PO BOX 17818, SALEM, OR 97305-7818
(503) 363-2021
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12-09-73
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263634042
—
OR
Enumeration date
07/09/2010
Last updated
12/15/2017
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