Provider Demographics
NPI:1760903959
Name:BOLTON, FAITH HELENE (CADC II/PSS/CRM/QMHA)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:HELENE
Last Name:BOLTON
Suffix:
Gender:F
Credentials:CADC II/PSS/CRM/QMHA
Other - Prefix:
Other - First Name:NOREEN
Other - Middle Name:HELENE
Other - Last Name:BOLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC II/PSS
Mailing Address - Street 1:211 SE CARUTHERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4502
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:971-260-0355
Practice Address - Street 1:17645 NW SAINT HELENS RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97231-1729
Practice Address - Country:US
Practice Address - Phone:503-621-1069
Practice Address - Fax:503-621-0200
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000001262175T00000X
OR21-01-20005101YA0400X
OR15-CRM-180101YA0400X
OR24-QMHA-R-5226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500758994Medicaid
OR500727800Medicaid