Provider Demographics
NPI:1831624337
Name:PRAH, ABENA
Entity type:Individual
Prefix:
First Name:ABENA
Middle Name:
Last Name:PRAH
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 1:1278 CABELAS DR
Mailing Address - Street 2:#332
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2111
Mailing Address - Country:US
Mailing Address - Phone:919-454-1665
Mailing Address - Fax:
Practice Address - Street 1:1278 CABELAS DR
Practice Address - Street 2:#332
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-2111
Practice Address - Country:US
Practice Address - Phone:919-454-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-22
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician