Provider Demographics
NPI:1174868731
Name:CUNDILL, GRIER (MA, NCACII, CADCIII)
Entity type:Individual
Prefix:MR
First Name:GRIER
Middle Name:
Last Name:CUNDILL
Suffix:
Gender:M
Credentials:MA, NCACII, CADCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-1103
Mailing Address - Country:US
Mailing Address - Phone:503-630-4703
Mailing Address - Fax:
Practice Address - Street 1:811 NW 20TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1445
Practice Address - Country:US
Practice Address - Phone:503-630-4703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR94-10-83101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)