Healthcare Provider Details

I. General information

NPI: 1932332293
Provider Name (Legal Business Name): ADWOA AGNES SEFA-BOAKYE B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 N GAREY AVE
POMONA CA
91767-2923
US

IV. Provider business mailing address

16076 PETERSON CT
CHINO HILLS CA
91709-7913
US

V. Phone/Fax

Practice location:
  • Phone: 909-629-2400
  • Fax:
Mailing address:
  • Phone: 909-248-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: