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1124668447
LAURIE JACKSON
PORTLAND, OR
NPI
1124668447
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Other Name
TINA FORTIN
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2020-01-14
Last Update Date
2021-12-29
Business Address
LAURIE JACKSON CADC
1122 NE 122ND AVE STE A102
PORTLAND, OR 97230-2082
Phone number: 855-237-9882
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Mailing Address
LAURIE JACKSON CADC
11400 SE 90TH AVE APT 1424
HAPPY VALLEY, OR 97086-2626
Phone number: 503-607-5791
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