Individual
AMANDA CANTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC, CADC I
Contact information
Practice address
12636 SE STARK ST, PLAZA 125 BUILDING J, PORTLAND, OR 97233-1058
(503) 253-4600
(503) 253-4609
Mailing address
PO BOX 82819, PORTLAND, OR 97282-0819
(503) 233-5405
(503) 233-2694
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
09-03-07
OR
101YP2500X
Professional Counselor
Primary
C2525
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
01
—
R0000WDBCH
MEDICARE GROUP
OR
Enumeration date
12/27/2007
Last updated
04/01/2011
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