JACOB ANDREW WELLIVER

PORTLAND, OR
NPI1821640947
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2019-07-09
Last Update Date2019-07-09
Business Address
JACOB ANDREW WELLIVER
847 NE 19TH AVE STE 100
PORTLAND, OR 97232-2684
Phone number: 503-238-0769
Mailing Address
JACOB ANDREW WELLIVER
PO BOX 8459
PORTLAND, OR 97207-8459
Phone number: 503-238-0769
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