Provider Demographics
NPI:1922865716
Name:FOSU, KWADWO ADDO (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KWADWO
Middle Name:ADDO
Last Name:FOSU
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23508 PURITAN PL
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2922
Mailing Address - Country:US
Mailing Address - Phone:646-271-0830
Mailing Address - Fax:
Practice Address - Street 1:9080 BEALE RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5633
Practice Address - Country:US
Practice Address - Phone:646-271-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD256301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical