Provider Demographics
NPI:1417093865
Name:TOLAND, WILLIAM DELRAY (AAS CADCII,QMHA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DELRAY
Last Name:TOLAND
Suffix:
Gender:M
Credentials:AAS CADCII,QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1151
Mailing Address - Street 2:
Mailing Address - City:TURNER
Mailing Address - State:OR
Mailing Address - Zip Code:97392-1151
Mailing Address - Country:US
Mailing Address - Phone:971-240-2253
Mailing Address - Fax:
Practice Address - Street 1:7525 SE LAKE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2115
Practice Address - Country:US
Practice Address - Phone:503-344-6075
Practice Address - Fax:503-344-4112
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06-03-46101YA0400X
OR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator