Provider Demographics
NPI:1598940769
Name:BEDIAKO, ABENA (LCSW)
Entity Type:Individual
Prefix:
First Name:ABENA
Middle Name:
Last Name:BEDIAKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11354
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-0354
Mailing Address - Country:US
Mailing Address - Phone:919-672-0712
Mailing Address - Fax:888-806-1537
Practice Address - Street 1:113 MURRAY HILL DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-3063
Practice Address - Country:US
Practice Address - Phone:919-672-0712
Practice Address - Fax:888-806-1537
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0059091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106834Medicaid