Individual
THEODORE LEE PEARSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC I
Contact information
Practice address
1122 NE 122ND AVE # 200, PORTLAND, OR 97230-2081
(503) 732-6653
Mailing address
PO BOX 1038, WEST TISBURY, MA 02575-1038
(503) 475-6246
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
20-05-10416
OR
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-05-10416
MHACBO
OR
Enumeration date
07/21/2022
Last updated
09/26/2023
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