Provider Demographics
NPI:1730885492
Name:ATEMKENG, ALBERT ABOUDEM (LGSW, LICSW)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:ABOUDEM
Last Name:ATEMKENG
Suffix:
Gender:
Credentials:LGSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 DARIAN DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9403
Mailing Address - Country:US
Mailing Address - Phone:651-500-9053
Mailing Address - Fax:
Practice Address - Street 1:2345 RICE ST STE 210
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3720
Practice Address - Country:US
Practice Address - Phone:651-500-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN244971041C0700X
104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker