Provider Demographics
NPI:1700110657
Name:ADU-POKU, QUEEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:QUEEN
Middle Name:
Last Name:ADU-POKU
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:PO BOX 2911
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-2911
Mailing Address - Country:US
Mailing Address - Phone:925-642-1218
Mailing Address - Fax:925-521-8715
Practice Address - Street 1:2810 LONE TREE WAY STE 9
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4956
Practice Address - Country:US
Practice Address - Phone:926-628-9948
Practice Address - Fax:925-521-8715
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical