Provider Demographics
NPI:1306844352
Name:AKUAMOAH-BOATENG, AGYENIM (LPC)
Entity Type:Individual
Prefix:
First Name:AGYENIM
Middle Name:
Last Name:AKUAMOAH-BOATENG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CANTER PL
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8675
Mailing Address - Country:US
Mailing Address - Phone:910-295-3257
Mailing Address - Fax:910-291-9913
Practice Address - Street 1:911 ATKINSON ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4718
Practice Address - Country:US
Practice Address - Phone:910-291-9909
Practice Address - Fax:910-291-9913
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102339Medicaid
NC6102025Medicaid