Individual
MR. ANTONIO LAVELLE DARSHIE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
527 SE MORRISON ST, PORTLAND, OR 97214-2300
(503) 501-5294
Mailing address
8915 SW CENTER ST, TIGARD, OR 97223-6307
(503) 726-3690
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/18/2019
Last updated
12/18/2019
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