Provider Demographics
NPI:1689713117
Name:DUGAN, JOHN LOUIS (CADC1)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LOUIS
Last Name:DUGAN
Suffix:
Gender:M
Credentials:CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 SE VINEYARD RD
Mailing Address - Street 2:#29
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-4706
Mailing Address - Country:US
Mailing Address - Phone:503-260-2614
Mailing Address - Fax:
Practice Address - Street 1:205 SE 3RD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4093
Practice Address - Country:US
Practice Address - Phone:503-693-3104
Practice Address - Fax:503-693-6474
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05-03-11101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)