Individual
MR. ANTHONY DOUGLAS DEJESUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDPT, CADC-R
Contact information
Practice address
12662 SE STARK ST, PORTLAND, OR 97233-1058
(503) 546-7677
(503) 517-7768
Mailing address
16203 NE 32ND ST, VANCOUVER, WA 98682-3674
(347) 988-2161
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60778717
WA
Other
Enumeration date
08/20/2019
Last updated
02/16/2021
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