Individual
SERGIO A GUTIERREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC II, QMHA II
Contact information
Practice address
182 SW ACADEMY STREET, DALLAS, OR 97338
(503) 623-9289
Mailing address
239 STONEWAY DRIVE NW, SALEM, OR 97304
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00-07-15
CADC CERFTIFICATION NUMBE
OR
Enumeration date
05/01/2007
Last updated
10/25/2024
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