Provider Demographics
NPI:1851842108
Name:SANKOFA COUNSELING, LLC
Entity Type:Organization
Organization Name:SANKOFA COUNSELING, LLC
Other - Org Name:MAYNARD COUNSELING AND CONSULTING, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-444-8214
Mailing Address - Street 1:PO BOX 20127
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97294-0127
Mailing Address - Country:US
Mailing Address - Phone:503-444-8214
Mailing Address - Fax:888-978-8164
Practice Address - Street 1:5014 NE 15TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-4406
Practice Address - Country:US
Practice Address - Phone:503-444-8214
Practice Address - Fax:888-978-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0084101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500804942Medicaid
OR500723905Medicaid