Provider Demographics
NPI:1578840849
Name:PACIFIC ALCOHOL & DRUG COUNSELING, INC.
Entity Type:Organization
Organization Name:PACIFIC ALCOHOL & DRUG COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALLENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:503-640-0110
Mailing Address - Street 1:157 SE BASELINE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123
Mailing Address - Country:US
Mailing Address - Phone:503-640-0110
Mailing Address - Fax:503-640-0107
Practice Address - Street 1:157 SE BASELINE ST
Practice Address - Street 2:SUITE A
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123
Practice Address - Country:US
Practice Address - Phone:503-640-0110
Practice Address - Fax:503-640-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OROAR4150510000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty