Individual
RAFAEL CAMARILLO MARTINEZ VILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12672 SE STARK ST, PORTLAND, OR 97233-1058
(503) 546-9975
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-23-3018
OR
101YM0800X
Mental Health Counselor
24-QMHA-R-4985
OR
175T00000X
Peer Specialist
22-CRM-1246
OR
Other
Enumeration date
02/23/2024
Last updated
02/23/2024
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