KHALIA TIDWELL

PORTLAND, OR
NPI1326874017
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Additional Taxonomies101YM0800X Counselor, Mental Health
Enumeration Date2024-09-10
Last Update Date2024-09-23
Business Address
KHALIA TIDWELL
6923 N FESSENDEN ST APT E
PORTLAND, OR 97203-1894
Phone number: 971-258-5803
Mailing Address
KHALIA TIDWELL
8915 SW CENTER ST
PORTLAND, OR 97223-6307
Phone number: 503-726-3690