Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 VILLAGE DR
GLEN CARBON IL
62034-2731
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 314-643-6412
  • Fax:
Mailing address:
  • Phone: 870-949-3540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180018243
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: