Provider Demographics
NPI:1962277699
Name:ANDERSON, DREW N (CDAC-R)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:N
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CDAC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15617 SW 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7920
Mailing Address - Country:US
Mailing Address - Phone:503-997-2987
Mailing Address - Fax:
Practice Address - Street 1:10920 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-8600
Practice Address - Country:US
Practice Address - Phone:503-244-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-23-3300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)