Provider Demographics
NPI:1457224859
Name:AMOATENG, GLENDA N
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:N
Last Name:AMOATENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S WHITING ST APT 616
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7135
Mailing Address - Country:US
Mailing Address - Phone:703-520-3618
Mailing Address - Fax:
Practice Address - Street 1:225 S WHITING ST APT 616
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7135
Practice Address - Country:US
Practice Address - Phone:703-520-3618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician