Provider Demographics
NPI:1023849379
Name:OWUSU-AGYEMANG, KWASI BONSU
Entity type:Individual
Prefix:
First Name:KWASI
Middle Name:BONSU
Last Name:OWUSU-AGYEMANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3787 MARY EVELYN WAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-8230
Mailing Address - Country:US
Mailing Address - Phone:571-275-2638
Mailing Address - Fax:
Practice Address - Street 1:3301 WHEELER RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4129
Practice Address - Country:US
Practice Address - Phone:571-275-2638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC200001519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty