Individual
DERRICK WOHALI RADFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
5441 S MACADAM AVE STE A, PORTLAND, OR 97239-3822
(971) 290-4398
Mailing address
5441 S MACADAM AVE STE A, PORTLAND, OR 97239-3822
(971) 290-4398
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
61660503
WA
101YM0800X
Mental Health Counselor
Primary
R9219
OR
101YP2500X
Professional Counselor
Primary
C8621
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C8621
OBLPCT
OR
Enumeration date
05/15/2023
Last updated
07/23/2026
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