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Individual

MS. KATHLEEN ANN DRAKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CADC I NCAC I

Contact information

Practice address
1508 SW HUME ST, PORTLAND, OR 97219-4267
(503) 954-4574
Mailing address
1508 SW HUME ST, PORTLAND, OR 97219-4267
(503) 954-4574

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
06-07-15
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
06-07-15
OR
171M00000X
Case Manager/Care Coordinator
06-07-15
OR

Other

Enumeration date
02/26/2007
Last updated
05/11/2012
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