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General NPI Number Information
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NPI Number | 1427784636
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Entity Type | Individual
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Provider Name | NANA ABA ASEDA OTABIL LPC-R
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Gender | Female
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 406 W FRANKLIN ST
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City | RICHMOND
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State | VA
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Zip | 23220-4906
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Country | US
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Telephone | 919-602-6766
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Fax | 919-402-1755
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Provider Business Mailing Address
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Address Line | 3622 LYCKAN PKWY STE 3002
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City | DURHAM
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State | NC
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Zip | 27707-2572
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Country | US
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Telephone | 919-602-6766
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Fax | 919-402-1755
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704012061
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License Number State | VA
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