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Contact Information

FATAI A POPOOLA, LICSW,LADC
525 PORTLAND AVE # MC963
MINNEAPOLIS, MN55415-1533
 Phone: 612-396-2280
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Addiction (Substance Use Disorder)

101YA0400X
 

Addiction (Substance Use Disorder)

103TA0400X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for FATAI A POPOOLA · (Male)

NPI # 1174035331
Status Active
Credentials LICSW,LADC
Entity Individual
Enumeration date 10/27/2017
Last updated 02/06/2025 - More than a year ago
Sole proprietor 1 Yes
Identifiers
  • MN License # 24938
  • MN License # 303521
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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