Provider Demographics
NPI:1033974548
Name:NTRAKWA, SAMUEL (MPH, MDIV)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:NTRAKWA
Suffix:
Gender:M
Credentials:MPH, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 GRAND AVE APT 3S
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1556
Mailing Address - Country:US
Mailing Address - Phone:706-294-3946
Mailing Address - Fax:
Practice Address - Street 1:8111 GRAND AVE APT 3S
Practice Address - Street 2:
Practice Address - City:RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60171-1556
Practice Address - Country:US
Practice Address - Phone:706-294-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist