Provider Demographics
NPI:1881211563
Name:CORA, FANTA AMADOU
Entity Type:Individual
Prefix:
First Name:FANTA
Middle Name:AMADOU
Last Name:CORA
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 1:340 123RD PL NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4818
Mailing Address - Country:US
Mailing Address - Phone:425-269-0493
Mailing Address - Fax:
Practice Address - Street 1:340 123RD PL NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4818
Practice Address - Country:US
Practice Address - Phone:425-269-0493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor