# PRIMECARE SUPPORT SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033079066
- **Authorized official:** KENNETH ASHU AGBOR OJONG (CEO)
- **Authorized official phone:** (240) 899-0339

## Contact information

- **Practice address:** 15004 OLDDALE RD, CENTREVILLE, VA 20120-1433
- **Practice address phone:** (240) 899-0339
- **Mailing address:** 15004 OLDDALE RD, CENTREVILLE, VA 20120-1433
- **Mailing address phone:** (240) 899-0339

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 261QD1600X | Developmental Disabilities Clinic/Center | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/12/2025
- **Last updated:** 11/12/2025