Individual
LEROY G BIGBOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC I
Contact information
Practice address
1631 SW COLUMBIA ST, PORTLAND, OR 97201-6025
(503) 231-2641
(503) 231-1654
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(971) 386-2278
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
01-P-03
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500656423
—
OR
Enumeration date
01/11/2006
Last updated
04/14/2017
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