Healthcare Provider Details

I. General information

NPI: 1326474594
Provider Name (Legal Business Name): MARC RAYMOND DOUTHIT CADCII
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 W 4TH AVE
EUGENE OR
97402
US

IV. Provider business mailing address

687 CHESHIRE AVE.
EUGENE OR
97402
US

V. Phone/Fax

Practice location:
  • Phone: 541-743-4340
  • Fax: 541-743-4369
Mailing address:
  • Phone: 541-684-4100
  • Fax: 541-684-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12-03-58
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500662506
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: