Individual
JACQUELINE B PANCOAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC I
Contact information
Practice address
1949 SE 122ND AVE, PORTLAND, OR 97233-1303
(971) 271-6313
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(971) 271-6313
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
04-11-30
OR
Other
Enumeration date
09/20/2012
Last updated
09/20/2012
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