Healthcare Provider Details

I. General information

NPI: 1932735883
Provider Name (Legal Business Name): AKOMA HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CHADWICK DR
STAFFORD VA
22556-4622
US

IV. Provider business mailing address

50 CHADWICK DR
STAFFORD VA
22556-4622
US

V. Phone/Fax

Practice location:
  • Phone: 240-459-8984
  • Fax:
Mailing address:
  • Phone: 404-933-0468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUSAN D AGYEMAN
Title or Position: OWNER
Credential: LPC, LSATP
Phone: 240-459-8984