Provider Demographics
NPI:1881263549
Name:AGYAPONG, PHYLLIS (LGMFT)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:AGYAPONG
Suffix:
Gender:F
Credentials:LGMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11820 PARKLAWN DR STE 540
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2566
Mailing Address - Country:US
Mailing Address - Phone:301-852-5500
Mailing Address - Fax:
Practice Address - Street 1:11820 PARKLAWN DR STE 540
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-2566
Practice Address - Country:US
Practice Address - Phone:301-852-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM826106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist