Provider Demographics
NPI:1851725097
Name:KOUASSI, AHLONKO (HHA)
Entity Type:Individual
Prefix:MR
First Name:AHLONKO
Middle Name:
Last Name:KOUASSI
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10153 CAMPUS WAY S
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2105
Mailing Address - Country:US
Mailing Address - Phone:301-404-3178
Mailing Address - Fax:
Practice Address - Street 1:10153 CAMPUS WAY S
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2105
Practice Address - Country:US
Practice Address - Phone:301-404-3178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA8126374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide