Individual
JANICE C. PREMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6400 SE LAKE RD STE 102, PORTLAND, OR 97222-2129
(503) 810-8111
Mailing address
6400 SE LAKE RD STE 102, PORTLAND, OR 97222-2129
(503) 810-8111
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
07-09-36
OR
101YP2500X
Professional Counselor
Primary
2044
OR
101YP2500X
Professional Counselor
85365
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07-09-36
CADC1
OR
Enumeration date
11/02/2007
Last updated
11/04/2007
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