Healthcare Provider Details

I. General information

NPI: 1417093865
Provider Name (Legal Business Name): WILLIAM DELRAY TOLAND AAS CADCII,QMHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 SE LAKE RD
MILWAUKIE OR
97267-2115
US

IV. Provider business mailing address

PO BOX 1151
TURNER OR
97392-1151
US

V. Phone/Fax

Practice location:
  • Phone: 503-344-6075
  • Fax: 503-344-4112
Mailing address:
  • Phone: 971-240-2253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number06-03-46
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: