Provider Demographics
NPI:1245761881
Name:FLEMING, DAVID A (CADC II)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:FLEMING
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31700 FAYETTEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SHEDD
Mailing Address - State:OR
Mailing Address - Zip Code:97377-9779
Mailing Address - Country:US
Mailing Address - Phone:503-208-9004
Mailing Address - Fax:
Practice Address - Street 1:31700 FAYETTEVILLE DR
Practice Address - Street 2:
Practice Address - City:SHEDD
Practice Address - State:OR
Practice Address - Zip Code:97377-9779
Practice Address - Country:US
Practice Address - Phone:503-208-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16-R-06101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health