Provider Demographics
NPI:1457798373
Name:BOATENG, AGARTHA AJOA (MSW,CAC 1)
Entity Type:Individual
Prefix:MRS
First Name:AGARTHA
Middle Name:AJOA
Last Name:BOATENG
Suffix:
Gender:F
Credentials:MSW,CAC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N HARVIN ST
Mailing Address - Street 2:P.O.BOX 39
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4956
Mailing Address - Country:US
Mailing Address - Phone:803-775-5080
Mailing Address - Fax:803-773-6256
Practice Address - Street 1:441 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4232
Practice Address - Country:US
Practice Address - Phone:803-775-5080
Practice Address - Fax:803-773-6256
Is Sole Proprietor?:No
Enumeration Date:2013-06-01
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1043215569Medicaid