Provider Demographics
NPI:1669125365
Name:OTTI OKYERE, GRACELOVE A (QASP-S)
Entity type:Individual
Prefix:MRS
First Name:GRACELOVE
Middle Name:A
Last Name:OTTI OKYERE
Suffix:
Gender:F
Credentials:QASP-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 TOWER OAKS BLVD FL 5
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4282
Mailing Address - Country:US
Mailing Address - Phone:301-444-5001
Mailing Address - Fax:
Practice Address - Street 1:454 INDIGO WAY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-2574
Practice Address - Country:US
Practice Address - Phone:703-479-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA16918106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst