Individual
LINDA HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
847 NE 19TH AVE, PORTLAND, OR 97232-2684
(503) 238-0769
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
PRE-CADC
OR
171M00000X
Case Manager/Care Coordinator
Primary
19-QMHA-I-00780
OR
372600000X
Adult Companion
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-QMHA-I-00780
QMHA
OR
Enumeration date
02/14/2017
Last updated
07/16/2019
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