Individual
MR. LEONARD CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CERTIFIED ALCOHOL &
Contact information
Practice address
4134 N. VANCOUVER AVE., SUITE 303C, PORTLAND, OR 97217-2900
(503) 593-7764
Mailing address
PO BOX 11629, 4134 N. VANCOUVER AVE., SUITE 303C, PORTLAND, OR 97217-2900
(503) 593-7764
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06-R-06
CADC II
OR
Enumeration date
05/15/2012
Last updated
05/15/2012
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