Provider Demographics
NPI:1609096528
Name:AMANKWATIA, KWABENA BOBIE (LPC, CAC, CCDP)
Entity Type:Individual
Prefix:MR
First Name:KWABENA
Middle Name:BOBIE
Last Name:AMANKWATIA
Suffix:
Gender:M
Credentials:LPC, CAC, CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5948
Mailing Address - Country:US
Mailing Address - Phone:610-752-6091
Mailing Address - Fax:
Practice Address - Street 1:52 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5948
Practice Address - Country:US
Practice Address - Phone:610-752-6091
Practice Address - Fax:610-974-9337
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004101101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALPCOtherLICENSED PROFESSIONAL COU