Individual
MS. TIFFANY D WOLLEAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADCI/CRMII/PSS/QMHA
Contact information
Practice address
620 NE 2ND ST, GRESHAM, OR 97030-7514
(971) 274-3757
(503) 912-5740
Mailing address
211 SE CARUTHERS ST, PORTLAND, OR 97214-4502
(503) 224-1044
(971) 260-0355
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
24-03-11057
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
24-CRM-II-0221
OR
101YM0800X
Mental Health Counselor
25-QMHA-R-6749
OR
175T00000X
Peer Specialist
THW000106154
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500806711
—
OR
05
—
500808225
—
OR
05
—
500856977
—
OR
Enumeration date
04/13/2022
Last updated
06/30/2025
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