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Individual

ZECHARIAH JOHNSON-BANIK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSS, QMHA-R

Contact information

Practice address
12360 E BURNSIDE ST, PORTLAND, OR 97233-1042
(971) 279-4800
(971) 279-2051
Mailing address
211 SE CARUTHERS ST, PORTLAND, OR 97214-4502
(503) 224-1044

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
24-QMHA-R-6024
OR
175T00000X
Peer Specialist
Primary
OR

Other

Enumeration date
08/20/2024
Last updated
12/16/2024
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