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Individual

ASHMABETT VERA-GONZALEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CADC

Contact information

Practice address
236 D STREET, MADRAS, OR 97754
(541) 475-5300
Mailing address
PO BOX 1710, REDMOND, OR 97756-0516
(541) 516-4087

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21-02-10075
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
21-02-1075
CADC
OR
Enumeration date
03/29/2021
Last updated
03/29/2021
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