Individual
IRVIN D WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC I
Contact information
Practice address
17645 NW SAINT HELENS RD, PORTLAND, OR 97231-1729
(503) 621-1069
(503) 621-0200
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20-11-14
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500776112
—
OR
Enumeration date
01/21/2020
Last updated
06/29/2022
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