Healthcare Provider Details

I. General information

NPI: 1851012934
Provider Name (Legal Business Name): ADAM LAWSON CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1184 MCGEE CT NE
KEIZER OR
97303-9443
US

IV. Provider business mailing address

PO BOX 20674
KEIZER OR
97307-0674
US

V. Phone/Fax

Practice location:
  • Phone: 503-304-4358
  • Fax:
Mailing address:
  • Phone: 503-304-4358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-22-1803
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: