Provider Demographics
NPI:1861197741
Name:ADOM, ABENA ODE
Entity type:Individual
Prefix:
First Name:ABENA
Middle Name:ODE
Last Name:ADOM
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 1:1034 REGIONAL PARK DR # 8109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-1117
Mailing Address - Country:US
Mailing Address - Phone:347-636-6575
Mailing Address - Fax:
Practice Address - Street 1:2601 WOODLAND PARK DR APT 8109
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6174
Practice Address - Country:US
Practice Address - Phone:347-636-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11883201104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker