Individual
AMANDA GENE EVANS MAHONY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC I
Contact information
Practice address
233 SW WALLULA AVE, GRESHAM, OR 97080-6858
(503) 597-3938
Mailing address
1204 SE BIDWELL ST, PORTLAND, OR 97202-6356
(503) 385-6033
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18-07-01U
OR
Other
Enumeration date
08/13/2018
Last updated
08/13/2018
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