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General NPI Number Information
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NPI Number | 1992022248
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Entity Type | Individual
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Provider Name | AKOSUA GYEABOA LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 2932 WESTLEIGH DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-2084
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Country | US
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Telephone | 317-748-4041
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Fax | 317-475-9693
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Provider Business Mailing Address
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Address Line | 1640 KESSLER BOULEVARD WEST DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46228-1955
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Country | US
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Telephone | 317-748-4041
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Fax | 317-475-9693
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34000416A
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License Number State | IN
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