Healthcare Provider Details

I. General information

NPI: 1083441521
Provider Name (Legal Business Name): EMMANUELA ADWOA OBUOBISA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 OVILLE ROAD
STAFFORD VA
22556
US

IV. Provider business mailing address

102 CORK ST
STAFFORD VA
22554-9431
US

V. Phone/Fax

Practice location:
  • Phone: 540-645-4777
  • Fax:
Mailing address:
  • Phone: 703-201-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: