Individual
DOROTHY R DE LA ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDAC II
Contact information
Practice address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2060
(503) 879-2071
Mailing address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2060
(035) 879-2071
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21-03-20041
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500764712
—
OR
Enumeration date
05/30/2018
Last updated
08/16/2021
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