Individual
MRS. NICOLE ALICIA KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC 1
Contact information
Practice address
3910 SE STARK ST, PORTLAND, OR 97214-3241
(503) 235-8655
Mailing address
5224 SE 92ND AVE, PORTLAND, OR 97266-3824
(971) 506-4816
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
101YM0800X
Mental Health Counselor
—
—
372600000X
Adult Companion
—
—
Other
Enumeration date
01/31/2007
Last updated
08/05/2016
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