Healthcare Provider Details

I. General information

NPI: 1447878889
Provider Name (Legal Business Name): GABRIEL ASARE SARPONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 RAILWAY AVENUE
SEWARD AK
99664
US

IV. Provider business mailing address

2320 E UNIVERSITY AVE APT 2
URBANA IL
61802-6203
US

V. Phone/Fax

Practice location:
  • Phone: 907-224-5257
  • Fax:
Mailing address:
  • Phone: 870-949-3540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: