Healthcare Provider Details

I. General information

NPI: 1831009554
Provider Name (Legal Business Name): CAROLINE CHAYADI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10763 SW GREENBURG RD # 100
TIGARD OR
97223-5492
US

IV. Provider business mailing address

760 NW 118TH AVE APT 102
PORTLAND OR
97229-5965
US

V. Phone/Fax

Practice location:
  • Phone: 503-558-6979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-25-6278
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: