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General NPI Number Information
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NPI Number | 1922562206
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Entity Type | Individual
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Provider Name | ELIZABETH MARIE RHOADES CADC CANDIDATE
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Gender | Female
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 1122 NE 122ND AVE
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City | PORTLAND
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State | OR
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Zip | 97230-2081
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Country | US
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Telephone | 503-954-1890
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Fax |
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Provider Business Mailing Address
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Address Line | 5364 SW LEE ST
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City | TUALATIN
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State | OR
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Zip | 97062-6873
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Country | US
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Telephone | 503-995-4987
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Fax |
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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 | T-18-185
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License Number State | OR
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