Provider Demographics
NPI:1083283980
Name:ADU-ANTOH, PRISCILLA D (LAC)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:D
Last Name:ADU-ANTOH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 STUYVESANT AVE APT A
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-5112
Mailing Address - Country:US
Mailing Address - Phone:214-267-9571
Mailing Address - Fax:
Practice Address - Street 1:1108 STUYVESANT AVE APT A
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-5112
Practice Address - Country:US
Practice Address - Phone:214-267-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00306500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health