Provider Demographics
NPI:1699945881
Name:ABROKWA-CLOTTEY, ALEX-ERIC KOFI
Entity type:Individual
Prefix:
First Name:ALEX-ERIC
Middle Name:KOFI
Last Name:ABROKWA-CLOTTEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 KARL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3603
Mailing Address - Country:US
Mailing Address - Phone:614-516-1812
Mailing Address - Fax:
Practice Address - Street 1:1813 NORTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-2859
Practice Address - Country:US
Practice Address - Phone:614-516-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 129343 IV164W00000X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No164W00000XNursing Service ProvidersLicensed Practical Nurse