Provider Demographics
NPI:1831954965
Name:OPPONG, AKWASI
Entity type:Individual
Prefix:
First Name:AKWASI
Middle Name:
Last Name:OPPONG
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 1:4244 E JESSE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0339
Mailing Address - Country:US
Mailing Address - Phone:480-824-8446
Mailing Address - Fax:
Practice Address - Street 1:4667 S LAKESHORE DR STE 7
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7293
Practice Address - Country:US
Practice Address - Phone:480-544-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst