Individual provider · Type 1 NPI

Deforrest Kwesi Jackson, CADC-1

Addiction (Substance Use Disorder) Counselor · Portland, OR

NPI number 1194356618 Active

Practice location

12670 NW Barnes Rd Ste 200
Portland, OR 97229-9001

Call (971) 232-3850 Map

Mailing address

11400 SE 90th Ave Apt 1424
Happy Valley, OR 97086-2626

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XT-20-047 (OR)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1194356618

Deforrest Kwesi Jackson, CADC-1's National Provider Identifier is 1194356618, issued on Feb 3, 2020. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Portland, OR. The record was last updated on Mar 3, 2022.