Individual
BRIAN FUQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2382 NW LOVEJOY ST, PORTLAND, OR 97210-3022
(503) 998-3954
Mailing address
2382 NW LOVEJOY ST, PORTLAND, OR 97210-3022
(503) 998-3954
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L7924
OR
Other
Enumeration date
05/19/2022
Last updated
05/19/2022
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