Provider Demographics
NPI:1992022248
Name:GYEABOA, AKOSUA (LCSW)
Entity Type:Individual
Prefix:
First Name:AKOSUA
Middle Name:
Last Name:GYEABOA
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 1:1640 KESSLER BOULEVARD WEST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-1955
Mailing Address - Country:US
Mailing Address - Phone:317-748-4041
Mailing Address - Fax:317-475-9693
Practice Address - Street 1:2932 WESTLEIGH DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2084
Practice Address - Country:US
Practice Address - Phone:317-748-4041
Practice Address - Fax:317-475-9693
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000416A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical