Individual
COLLIN WHITE-PEDEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1825 NE GLISAN ST, PORTLAND, OR 97232-2844
(503) 963-7676
(503) 764-9042
Mailing address
4101 NE DIVISION ST, 100, GRESHAM, OR 97030-4617
(503) 666-3808
(503) 666-6835
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274147
—
OR
Enumeration date
06/28/2013
Last updated
01/22/2020
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