Healthcare Provider Details

I. General information

NPI: 1174498216
Provider Name (Legal Business Name): EUNICE AGYEIWAA OKOREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/24/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 GREEN CRESCENT CT # 220
GREENBELT MD
20770-3098
US

IV. Provider business mailing address

6801 GREEN CRESCENT CT
GREENBELT MD
20770-3098
US

V. Phone/Fax

Practice location:
  • Phone: 202-805-4807
  • Fax: 202-805-4807
Mailing address:
  • Phone: 202-805-4807
  • Fax: 202-805-4807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25432406
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: