Provider Demographics
NPI:1285341842
Name:ACHENDUNGBONG, JOHNPAUL ASABA II
Entity type:Individual
Prefix:
First Name:JOHNPAUL
Middle Name:ASABA
Last Name:ACHENDUNGBONG
Suffix:II
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 1:1506 FAIRLAKES PL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3102
Mailing Address - Country:US
Mailing Address - Phone:240-938-3394
Mailing Address - Fax:
Practice Address - Street 1:1506 FAIRLAKES PL
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3102
Practice Address - Country:US
Practice Address - Phone:240-938-3394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical