Provider Demographics
NPI:1053725630
Name:ASAKU-YEBOAH, MICHAEL OFORI (LCADC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:OFORI
Last Name:ASAKU-YEBOAH
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2931
Mailing Address - Country:US
Mailing Address - Phone:908-656-0122
Mailing Address - Fax:
Practice Address - Street 1:405 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1806
Practice Address - Country:US
Practice Address - Phone:973-220-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00212100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)