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1316644735
MIKE C THEODORE
BEAVERTON, OR
NPI
1316644735
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NY 35007)
Enumeration Date
2023-02-15
Last Update Date
2023-02-15
Business Address
MIKE C THEODORE QMHA
17933 NW EVERGREEN PKWY STE 111
BEAVERTON, OR 97006-7452
Phone number: 814-243-0414
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Mailing Address
MIKE C THEODORE QMHA
3159 CARPENTERS PARK RD
DAVIDSVILLE, PA 15928-9223
Phone number: 814-243-0414
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