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Mr. Jackie Eugene Johnson SR., CADCII/QMHP-C,CSWA
Addiction (Substance Use Disorder) Counselor in Gresham, Oregon
NPI 1770745457

Jackie Eugene Johnson SR. is an Addiction (Substance Use Disorder) Counselor based in Portland, OR and is specialized in Addiction (Substance Use Disorder). Jackie Eugene Johnson SR. practices in Gresham, OR and has the professional credentials of CADCII/QMHP-C,CSWA. The NPI Number for Jackie Eugene Johnson SR. is 1770745457 and holds a License No. 17-CRM-078 (Oregon).

The current practice location address for Jackie Eugene Johnson SR. is 355 Nw Division St, Gresham, OR and can be reached out via phone at 503-231-2641 and via fax at 503-231-1654.

Location: 355 Nw Division St, Gresham, OR, 97205-1715
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1770745457
Provider Name
Jackie Eugene Johnson SR.
Credential
CADCII/QMHP-C,CSWA
Provider Entity Type
Individual
Gender
Male
Address
355 Nw Division St, Gresham, OR, 97205-1715
Phone Number
503-231-2641
Fax Number
503-231-1654
Provider Enumeration Date
06/25/2008
Last Update Date
02/15/2025
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Provider's Legacy Identifiers
Identifier Type State Issuer
500800849 05 OR
500801135 05 OR
institution
Provider Business Practice Location Address Details
Address
355 Nw Division St
City
Gresham
State
Oregon
Zip
97030-5523
Phone Number
503-231-2641
Fax Number
503-231-1654
person
Provider Business Mailing Address Details
Address
355 Nw Division St
City
Gresham
State
Oregon
Zip
97030-5523
Phone Number
503-231-2641
Fax Number
503-231-1654
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
A11750 (Oregon)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
24-QMHPC-001514 (Oregon)
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Behavioral Health & Social Service Providers
Classification
Social Worker
Speciality
Clinical
Taxonomy
1041C0700X
License No.
17-CRM-078 (Oregon)
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
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