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Organization
PRIMECARE SUPPORT SERVICES LLC
Active
Organization
PRIMECARE SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH ASHU AGBOR OJONG (CEO)
(240) 899-0339
Entity
Organization
Contact information
Practice address
15004 OLDDALE RD, CENTREVILLE, VA 20120-1433
(240) 899-0339
Mailing address
15004 OLDDALE RD, CENTREVILLE, VA 20120-1433
(240) 899-0339
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
NULL
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
251E00000X
Home Health Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
261QA0600X
Adult Day Care Clinic/Center
—
NULL
261QC1500X
Community Health Clinic/Center
Primary
—
NULL
261QD1600X
Developmental Disabilities Clinic/Center
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
Other
Enumeration date
11/12/2025
Last updated
11/12/2025
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