Provider Demographics
NPI:1821670597
Name:AKUDIHOR, ST.ENNAH BO'KARE
Entity type:Individual
Prefix:
First Name:ST.ENNAH
Middle Name:BO'KARE
Last Name:AKUDIHOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 RUSTLEWOOD LN SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-1834
Mailing Address - Country:US
Mailing Address - Phone:504-382-0080
Mailing Address - Fax:
Practice Address - Street 1:3133 RUSTLEWOOD LN SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-1834
Practice Address - Country:US
Practice Address - Phone:360-226-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW615593481041C0700X
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical