Provider Demographics
NPI:1427784636
Name:OTABIL, NANA ABA ASEDA (LPC-R)
Entity type:Individual
Prefix:
First Name:NANA ABA
Middle Name:ASEDA
Last Name:OTABIL
Suffix:
Gender:F
Credentials:LPC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 LYCKAN PKWY STE 3002
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2572
Mailing Address - Country:US
Mailing Address - Phone:919-602-6766
Mailing Address - Fax:919-402-1755
Practice Address - Street 1:406 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4906
Practice Address - Country:US
Practice Address - Phone:919-602-6766
Practice Address - Fax:919-402-1755
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704012061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health