Healthcare Provider Details

I. General information

NPI: 1578840849
Provider Name (Legal Business Name): PACIFIC ALCOHOL & DRUG COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 SE BASELINE ST SUITE A
HILLSBORO OR
97123
US

IV. Provider business mailing address

157 SE BASELINE ST SUITE A
HILLSBORO OR
97123
US

V. Phone/Fax

Practice location:
  • Phone: 503-640-0110
  • Fax: 503-640-0107
Mailing address:
  • Phone: 503-640-0110
  • Fax: 503-640-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberOAR4150510000
License Number StateOR

VIII. Authorized Official

Name: MRS. JENNIFER A WALLENSTEIN
Title or Position: EXECUTIVE DIRECTOR/OWNER
Credential: CADC II
Phone: 503-640-0110