Provider Demographics
NPI:1073239828
Name:ASONG, ANNY NDOUMBE
Entity Type:Individual
Prefix:
First Name:ANNY
Middle Name:NDOUMBE
Last Name:ASONG
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 1:1102 GOLDEN WILLOW PL
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7175
Mailing Address - Country:US
Mailing Address - Phone:614-598-5227
Mailing Address - Fax:
Practice Address - Street 1:1102 GOLDEN WILLOW PL
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-7175
Practice Address - Country:US
Practice Address - Phone:614-598-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities