Individual
MR. SOVANN DARA PEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
12 SE 14TH AVE, #104, PORTLAND, OR 97214-1404
(571) 207-4718
Mailing address
12 SE 14TH AVE, #104, PORTLAND, OR 97214-1404
(571) 207-4718
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C2800
OR
Other
Enumeration date
02/13/2012
Last updated
02/13/2012
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