Individual
KEVIN ANTHONY MICHAELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC 1
Contact information
Practice address
1027 E BURNSIDE ST, PORTLAND, OR 97214-1328
(503) 236-2290
(503) 239-8407
Mailing address
1027 E BURNSIDE, CODA, PORTLAND, OR 97214
(503) 236-2290
(503) 239-8407
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/23/2013
Last updated
02/17/2015
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