Provider Demographics
NPI:1154199206
Name:AFFESSI, FATIM
Entity type:Individual
Prefix:MISS
First Name:FATIM
Middle Name:
Last Name:AFFESSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 S 3NOTCH ST APT 318
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-2593
Mailing Address - Country:US
Mailing Address - Phone:334-492-0666
Mailing Address - Fax:
Practice Address - Street 1:4035 NE SANDY BLVD STE 240
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5331
Practice Address - Country:US
Practice Address - Phone:971-940-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional