Individual
KRYSTAL JOANN MAZZOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M. ED.
Contact information
Practice address
4310 NE KILLINGSWORTH ST, PORTLAND, OR 97218-1404
(503) 535-1150
(503) 528-0800
Mailing address
4310 NE KILLINGSWORTH ST, PORTLAND, OR 97218-1404
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
09/30/2011
Last updated
09/30/2011
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