Provider Demographics
NPI:1194281824
Name:ASAMBANG, DIEUDONNE ACHUNCHE (LADC)
Entity type:Individual
Prefix:
First Name:DIEUDONNE
Middle Name:ACHUNCHE
Last Name:ASAMBANG
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 ZANZIBAR LN N APT 210
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1674
Mailing Address - Country:US
Mailing Address - Phone:651-983-3003
Mailing Address - Fax:
Practice Address - Street 1:2301 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3709
Practice Address - Country:US
Practice Address - Phone:612-588-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305031101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)