DEFORREST KWESI JACKSON

PORTLAND, OR
NPI1194356618
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OR  T-20-047)
Enumeration Date2020-02-03
Last Update Date2022-03-03
Business Address
DEFORREST KWESI JACKSON CADC-1
12670 NW BARNES RD STE 200
PORTLAND, OR 97229-9001
Phone number: 971-232-3850
Mailing Address
DEFORREST KWESI JACKSON CADC-1
11400 SE 90TH AVE APT 1424
HAPPY VALLEY, OR 97086-2626
Phone number: 503-432-7975
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