Individual
GEORGE IVAR HANNIBAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, CADCI
Contact information
Practice address
1419 NE 69TH AVE, PORTLAND, OR 97213-5301
(503) 254-1545
(503) 525-2846
Mailing address
1419 NE 69TH AVE, PORTLAND, OR 97213-5301
(503) 254-1545
(503) 525-2846
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
01-11-26
OR
1041C0700X
Clinical Social Worker
L0525
OR
Other
Enumeration date
05/11/2006
Last updated
09/11/2025
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