Provider Demographics
NPI:1528751484
Name:ADUSEI, ABA
Entity type:Individual
Prefix:
First Name:ABA
Middle Name:
Last Name:ADUSEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 DAHLGREN PL
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2602
Mailing Address - Country:US
Mailing Address - Phone:571-477-8172
Mailing Address - Fax:703-221-9746
Practice Address - Street 1:3641 DAHLGREN PL
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2602
Practice Address - Country:US
Practice Address - Phone:571-477-8172
Practice Address - Fax:703-221-9746
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4007320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities