Individual
WAYNE MARTIN MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADCI
Contact information
Practice address
16000 SE POWELL BLVD UNIT 65, PORTLAND, OR 97236-1783
(503) 239-5738
(503) 239-8429
Mailing address
16000 SE POWELL BLVD UNIT 65, PORTLAND, OR 97236-1783
(503) 239-5738
(503) 239-8429
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
09-09-31
OR
Other
Enumeration date
07/13/2010
Last updated
07/13/2010
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