Provider Demographics
NPI:1427545961
Name:VALUE CREATION COUNSELING
Entity Type:Organization
Organization Name:VALUE CREATION COUNSELING
Other - Org Name:KWABENA SIAKA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIAKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD CAND, QMHP, CADC
Authorized Official - Phone:207-370-4115
Mailing Address - Street 1:2028 SE MARION ST APT 11
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7365
Mailing Address - Country:US
Mailing Address - Phone:207-370-4115
Mailing Address - Fax:
Practice Address - Street 1:2028 SE MARION ST APT 11
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7365
Practice Address - Country:US
Practice Address - Phone:503-422-6021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16-11-25261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)