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General NPI Number Information
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NPI Number | 1093018459
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Entity Type | Individual
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Provider Name | CANDIA ELLIOTT CADC II
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Gender | Female
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 709 NW EVERETT ST
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City | PORTLAND
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State | OR
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Zip | 97209-3517
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Country | US
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Telephone | 503-266-4060
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Fax | 503-445-4913
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Provider Business Mailing Address
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Address Line | 232 NW 6TH AVE
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City | PORTLAND
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State | OR
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Zip | 97209-3609
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Country | US
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Telephone | 503-200-3923
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Fax | 503-241-7419
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 99-11-62
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License Number State | OR
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