Basic Information
| Provider Information | |||||||||
| NPI: | 1932332293 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEFA-BOAKYE | ||||||||
| FirstName: | ADWOA | ||||||||
| MiddleName: | AGNES | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16076 PETERSON CT | ||||||||
| Address2: | |||||||||
| City: | CHINO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917097913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092481132 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1890 N GAREY AVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917672923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096292400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2009 | ||||||||
| LastUpdateDate: | 09/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | ICAN861 | 01 | CA | LA COUNTY DMH | OTHER |