Geramie Mark McCormick, CRM II, CADC-R
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Coburg, OR
NPI 1003686304 · NPPES record last updated Jan 8, 2024
Key facts
- NPI
- 1003686304
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- T-23-2430 (OR)
- Practice address
- 91150 N Coburg Industrial Way
Coburg, OR 97408-9512 - Phone
- (541) 284-5645
- NPI assigned
- Jan 8, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-23-2430 | OR | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | T-23-2430 | OR | Yes |
Addresses
Primary practice location
91150 N Coburg Industrial Way
Coburg, OR 97408-9512
Mailing address
91150 N Coburg Industrial Way
Coburg, OR 97408-9512
Phone (541) 606-6281
Other providers in Coburg, OR
- Lindsay P Maghan
- Mason Anthony Marin
- Gavon Marino
- Nehemiah Marshall
- Bruce E. Matthews
- Jodi Elaine Miller
- Kristine Teresa Miller
- Samantha Mitchell
- Annabel Morris
- Brittany Morrison
All providers in Coburg, OR · Addiction (Substance Use Disorder) Counselor in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.