Individual
FELESIA OTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC II
Contact information
Practice address
3910 SE STARK ST, PORTLAND, OR 97214-3241
(503) 595-3477
Mailing address
3910 SE STARK ST, PORTLAND, OR 97214-3241
(503) 595-3477
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
06-07-64
OR
Other
Enumeration date
09/16/2014
Last updated
09/16/2014
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