Individual
VALYN LEE KEITH-JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC 1
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
24-R-29
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
SC3245
MD
Other
Enumeration date
02/20/2024
Last updated
10/23/2024
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