Provider Demographics
NPI:1912596933
Name:QUEEN ADU-POKU LICENSED CLINICAL SOCIAL WORKER PC
Entity Type:Organization
Organization Name:QUEEN ADU-POKU LICENSED CLINICAL SOCIAL WORKER PC
Other - Org Name:ROYAL EMOTIONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUEEN
Authorized Official - Middle Name:LM
Authorized Official - Last Name:ADU-POKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-642-1218
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:925-642-1218
Practice Address - Fax:925-521-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty