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Anthony Michell Lathan, CADC-R/QMHP
Addiction (Substance Use Disorder) Counselor in Portland, Oregon
NPI 1316603053

Anthony Michell Lathan is an Addiction (Substance Use Disorder) Counselor based in Portland, OR and is specialized in Addiction (Substance Use Disorder). Anthony Michell Lathan practices in Portland, OR and has the professional credentials of CADC-R/QMHP. The NPI Number for Anthony Michell Lathan is 1316603053 and holds a License No. (Oregon).

The current practice location address for Anthony Michell Lathan is 1310 Sw 17Th Ave, Portland, OR and can be reached out via phone at 503-231-2641 and via fax at 503-467-4077.

Location: 1310 Sw 17Th Ave, Portland, OR, 97205-1715
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Provider Profile Details
NPI Number
1316603053
Provider Name
Anthony Michell Lathan
Credential
CADC-R/QMHP
Provider Entity Type
Individual
Gender
Male
Address
1310 Sw 17Th Ave, Portland, OR, 97205-1715
Phone Number
503-231-2641
Fax Number
503-467-4077
Provider Enumeration Date
11/16/2021
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
500813163 05 OR
500813165 05 OR
institution
Provider Business Practice Location Address Details
Address
1310 Sw 17Th Ave
City
State
Zip
97201-2522
Phone Number
503-231-2641
Fax Number
503-467-4077
person
Provider Business Mailing Address Details
Address
1310 Sw 17Th Ave
City
State
Zip
97201-2522
Phone Number
503-231-2641
Fax Number
503-467-4077
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
T-21-1167 (Oregon)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
(Oregon)
Definition
Definition to come...
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