=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942128996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALUE CREATION EDUCATIONAL AND COUNSELING SERVICES PDX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2026
-----------------------------------------------------
Last Update Date | 07/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3612 N FARRAGUT ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97217-5953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-220-5876
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4784 N LOMBARD ST STE B
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97203-4565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-220-5876
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR/FOUNDER
-----------------------------------------------------
Name | MR. KWABENA SIAKA
-----------------------------------------------------
Credential | CADC3, QMHPC
-----------------------------------------------------
Telephone | 971-220-5876
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------