Individual
ONA CRUISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS CDP CADC II
Contact information
Practice address
9735 SW SHADY LN STE 103, TIGARD, OR 97223-5481
(971) 727-8333
Mailing address
9735 SW SHADY LN STE 103, TIGARD, OR 97223-5481
(971) 727-8333
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13-R-27
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP60296116
WA
Other
Enumeration date
11/07/2013
Last updated
08/05/2016
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