Provider Demographics
NPI:1992359889
Name:SARPONG, FAUSTINA DARKO
Entity Type:Individual
Prefix:
First Name:FAUSTINA
Middle Name:DARKO
Last Name:SARPONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 WHITMER DR APT 10
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2925
Mailing Address - Country:US
Mailing Address - Phone:571-274-7059
Mailing Address - Fax:
Practice Address - Street 1:ALEXANDRIA RESIDENTIAL TREATMENT CENTER
Practice Address - Street 2:2355 MILL RD
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314
Practice Address - Country:US
Practice Address - Phone:730-746-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001264302163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse