Individual
ABDUL FOFANAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
847 NE 19TH AVE STE 100, PORTLAND, OR 97232-2684
(503) 238-0769
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/04/2016
Last updated
09/26/2017
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