Healthcare Provider Details

I. General information

NPI: 1508614272
Provider Name (Legal Business Name): ANGELINA MICHELLE PIERCE CADC, CRM II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 8549
COBURG OR
97408-1313
US

IV. Provider business mailing address

PO BOX 8549
COBURG OR
97408-1313
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-1110
  • Fax:
Mailing address:
  • Phone: 541-687-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: