Individual
LORI WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC I
Contact information
Practice address
91150 COBURG INDUSTRIAL WAY, COBURG, OR 97408
(541) 284-5740
Mailing address
91150 COBURG INDUSTRIAL WAY, COBURG, OR 97408
(541) 284-5740
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15-08-18
OR
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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