Individual
MIRANDA LATTIMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1817 NE 6TH AVE, PORTLAND, OR 97212-3960
(503) 719-7985
Mailing address
835 NE 114TH AVE, PORTLAND, OR 97220-2246
(415) 524-3098
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
12/28/2023
Last updated
12/28/2023
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