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General NPI Number Information
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NPI Number | 1053081588
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Entity Type | Organization
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Legal Business Name | BUABENG FAMILY LLC
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 7423 PICARDY AVE STE D
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City | BATON ROUGE
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State | LA
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Zip | 70808-4362
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Country | US
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Telephone | 225-228-2564
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Fax |
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Provider Business Mailing Address
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Address Line | 7423 PICARDY AVE STE D
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City | BATON ROUGE
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State | LA
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Zip | 70808-4362
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Country | US
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Telephone | 225-228-2564
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KWAME BAUBENG
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Credential | MD
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Telephone | 757-373-3551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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