Provider Demographics
NPI:1932734415
Name:AGYEPONG, LADY ESTHER (LCSW)
Entity Type:Individual
Prefix:
First Name:LADY ESTHER
Middle Name:
Last Name:AGYEPONG
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 1:625 N HAMILTON ST UNIT 53
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-3996
Mailing Address - Country:US
Mailing Address - Phone:480-310-6464
Mailing Address - Fax:
Practice Address - Street 1:625 N HAMILTON ST UNIT 53
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3996
Practice Address - Country:US
Practice Address - Phone:480-310-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16546101YP2500X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health