Healthcare Provider Details

I. General information

NPI: 1326409038
Provider Name (Legal Business Name): GLORIA OKAFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 4TH PLAIN BLVD BLDG 17, C106
VANCOUVER WA
98661-3713
US

IV. Provider business mailing address

PO BOX 2489
VANCOUVER WA
98668-2489
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-8474
  • Fax: 360-397-8499
Mailing address:
  • Phone: 360-397-8479
  • Fax: 360-397-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCG60389354
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: