Individual
JOHN GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC I
Contact information
Practice address
TSNW 948 NE 102ND ST., SUITE 101, PORTLAND, OR 97220
(503) 257-0381
Mailing address
984 NE 102ND ST, SUITE 101, PORTLAND, OR 97220
(503) 257-0381
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
03-03-17
OR
Other
Enumeration date
11/20/2013
Last updated
11/20/2013
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