Ketrick Devon Pendergrass I
Ketrick Devon Pendergrass I is an Addiction (Substance Use Disorder) Counselor in Coburg, Oregon. Licensed in Oregon. Registered with an NPI since 2022.
- Licensed in
- OR
- In the registry since
- 2022
- Specialties on file
- 2
Practice location Address checks out
1 Serenity LnCoburg, OR 97408-9350
Phone: (541) 687-1110
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Specialties & licences
| Addiction (Substance Use Disorder) Counselor (primary) | Taxonomy 101YA0400X · Licence T-22-2069 (OR) |
|---|---|
| Addiction (Substance Use Disorder) Counselor | Taxonomy 101YA0400X |
Record details
| NPI number | 1992412035 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | October 28, 2022 |
| Last updated in NPPES | October 28, 2022 |
| Certification date | October 26, 2022 |
| Mailing address | 1 Serenity Ln, Coburg, OR 97408-9350 |
Other providers in Coburg
-
Karen Louise Mount
91150 N Coburg Industrial Way, Coburg, OR 97408-9512 · (541) 687-1110
-
Hannah Mullens, CADC-R, CRM, PSS
PO Box 8549, Coburg, OR 97408-1313 · (541) 687-1110
-
Robert J Mulstay, CADC-R
1 Serenity Ln, Coburg, OR 97408-9350 · (541) 337-1098
-
Christina Natali
91150 N Coburg Industrial Way, Coburg, OR 97408-9512 · (541) 687-1110
-
Megan Aubrey Phinney
91150 Coburg Industrial Way, Coburg, OR 97408 · (541) 687-1110
-
Monica Powell
1 Serenity Ln, Coburg, OR 97408-9350 · (541) 687-1110
-
Colleen Johnette Prior, CADC1
91150 N Coburg Industrial Way, Coburg, OR 97408-9512 · (541) 687-1110
-
John Ramirez Escobar
1 Serenity Ln, Coburg, OR 97408-9350 · (541) 687-1110