Provider Demographics
NPI:1982898201
Name:WOTICHA, ABDELA MILO (COUNSELOR-MH --MSW)
Entity Type:Individual
Prefix:MR
First Name:ABDELA
Middle Name:MILO
Last Name:WOTICHA
Suffix:
Gender:M
Credentials:COUNSELOR-MH --MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 LLOYD CTR STE 2214
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1315
Mailing Address - Country:US
Mailing Address - Phone:503-494-4222
Mailing Address - Fax:503-494-6143
Practice Address - Street 1:2201 LLOYD CTR STE 2214
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1315
Practice Address - Country:US
Practice Address - Phone:503-494-7064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1982898201Medicaid