Provider Demographics
NPI:1104291277
Name:PURINGTON, DREANA MAE (CADC1)
Entity type:Individual
Prefix:MRS
First Name:DREANA
Middle Name:MAE
Last Name:PURINGTON
Suffix:
Gender:F
Credentials:CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19422 S MUNSON RD
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-8666
Mailing Address - Country:US
Mailing Address - Phone:503-970-5724
Mailing Address - Fax:
Practice Address - Street 1:511 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1830
Practice Address - Country:US
Practice Address - Phone:503-655-1029
Practice Address - Fax:503-655-4705
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-10-14101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)