Deforrest Kwesi Jackson, CADC-1
Counselor, Addiction (Substance Use Disorder) in Portland, OR. Individual provider (NPI-1).
NPI number1194356618
StatusActive
Last updated in NPPESMar 3, 2022
Details
- NPI
- 1194356618
- Entity type
- Individual (NPI-1)
- Name
- Deforrest Kwesi Jackson
- Credential
- CADC-1
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 3, 2020
- Certification date
- Mar 3, 2022
- Last updated
- Mar 3, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | T-20-047 | OR | Yes |
Practice location
12670 Nw Barnes Rd Ste 200Portland, OR 97229-9001
Phone 971-232-3850
Mailing address
11400 Se 90th Ave Apt 1424Happy Valley, OR 97086-2626
Phone 503-432-7975
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