Provider Demographics
NPI:1922833136
Name:AMOA, CONSTANT JR
Entity type:Individual
Prefix:
First Name:CONSTANT
Middle Name:
Last Name:AMOA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E IRVIN AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3402
Mailing Address - Country:US
Mailing Address - Phone:301-825-2466
Mailing Address - Fax:
Practice Address - Street 1:7420 HAYWARD RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-2507
Practice Address - Country:US
Practice Address - Phone:240-575-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health