Provider Demographics
NPI:1215443353
Name:TEQUABO, HENOCK W
Entity type:Individual
Prefix:
First Name:HENOCK
Middle Name:W
Last Name:TEQUABO
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 1:6536 ROSEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-4347
Mailing Address - Country:US
Mailing Address - Phone:614-556-7233
Mailing Address - Fax:
Practice Address - Street 1:6536 ROSEBROOK LN
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-4347
Practice Address - Country:US
Practice Address - Phone:614-556-7233
Practice Address - Fax:614-556-7233
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor