Healthcare Provider Details

I. General information

NPI: 1265186779
Provider Name (Legal Business Name): CAROL M DANFORD CADC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46314 TIMINE WAY
PENDLETON OR
97801-9417
US

IV. Provider business mailing address

PO BOX 160
PENDLETON OR
97801-0160
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax:
Mailing address:
  • Phone: 541-966-9830
  • Fax: 541-240-8754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20-07-02
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: