Individual
DIETRICH LAMONT MCDANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADCII/CRM/PSS/QMHAI
Contact information
Practice address
620 NE 2ND ST, GRESHAM, OR 97030-7514
(971) 274-3757
(503) 912-5740
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(971) 260-0355
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17-CRM-068
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
22-11-20216
OR
101YM0800X
Mental Health Counselor
23-QMHA-I-003592
OR
175T00000X
Peer Specialist
THW000001862
OR
Other
Enumeration date
05/30/2018
Last updated
10/15/2024
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