Provider Demographics
NPI:1275002529
Name:TWENEBOAH KODUAH, KWABENA
Entity Type:Individual
Prefix:
First Name:KWABENA
Middle Name:
Last Name:TWENEBOAH KODUAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 FAIRFIELD AVE # APTTB
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2565
Mailing Address - Country:US
Mailing Address - Phone:202-489-7474
Mailing Address - Fax:
Practice Address - Street 1:9812 FARM POND RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-6001
Practice Address - Country:US
Practice Address - Phone:240-535-7209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator