Provider Demographics
NPI:1366016008
Name:ANOMA, AMOA ACKAH CHARLES LE BON
Entity Type:Individual
Prefix:MR
First Name:AMOA ACKAH
Middle Name:CHARLES LE BON
Last Name:ANOMA
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 1:5921 CHERRYWOOD TER APT 302
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4279
Mailing Address - Country:US
Mailing Address - Phone:202-361-1501
Mailing Address - Fax:
Practice Address - Street 1:1651 CROFTON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1314
Practice Address - Country:US
Practice Address - Phone:443-302-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD63288428Medicaid