Provider Demographics
NPI:1417797598
Name:AGYEMANG, AMA (LCWSA)
Entity type:Individual
Prefix:
First Name:AMA
Middle Name:
Last Name:AGYEMANG
Suffix:
Gender:F
Credentials:LCWSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 STANDING ROCK WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1090
Mailing Address - Country:US
Mailing Address - Phone:919-881-9650
Mailing Address - Fax:
Practice Address - Street 1:1612 ARAPAHOE RIDGE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-9706
Practice Address - Country:US
Practice Address - Phone:919-885-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP020049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health