Individual
MR. ANDRE OTIS WHITE II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
707 NE COUCH ST, PORTLAND, OR 97232-2922
(503) 542-4603
(503) 233-6093
Mailing address
707 NE COUCH ST, PORTLAND, OR 97232-2922
(503) 542-4603
(503) 233-6093
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0177
SOCIAL SERVICE
OR
Enumeration date
04/15/2016
Last updated
04/15/2016
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