Individual
DYLAN WEERATUNGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC CANDIDATE/QMHA
Contact information
Practice address
847 NE 19TH AVE STE 100, PORTLAND, OR 97232
(503) 238-0769
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-17-256
OR
101YM0800X
Mental Health Counselor
—
OR
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500724989
—
OR
Enumeration date
10/07/2016
Last updated
06/12/2018
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