Provider Demographics
NPI:1558616524
Name:MCNAIR, WYNDHAM PIERCE (CADC I)
Entity Type:Individual
Prefix:MR
First Name:WYNDHAM
Middle Name:PIERCE
Last Name:MCNAIR
Suffix:
Gender:M
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 3007
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208
Mailing Address - Country:US
Mailing Address - Phone:503-535-1150
Mailing Address - Fax:503-535-1191
Practice Address - Street 1:1312 SW WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2327
Practice Address - Country:US
Practice Address - Phone:503-535-1150
Practice Address - Fax:503-535-1191
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11-06--50101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11-06-50OtherACCBO CADC I A&D CERTIFICATION