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Contact Information

TISE AFUOLA, AA, SUDPT
748 14TH AVE
LONGVIEW, WA98632-2315
 Phone: 360-200-5419
 Fax: 360-200-6736
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Other Service Providers

175T00000X
Indicates primary specialty

NPI Profile & details for TISE AFUOLA · (Male)

NPI Number 1992391742
Status Active
Credentials AA, SUDPT
Entity Individual
Enumeration date 12/16/2020
Last updated 03/31/2026 - About 2 months ago
Sole proprietor 1 No
Identifiers
  • WA License # CG61158364
  • WA License # PR70152743
  • WA Medicaid 2168939
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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