Healthcare Provider Details

I. General information

NPI: 1417507203
Provider Name (Legal Business Name): MR. NELSON NGWA BALINGWE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N ST NW STE 1
WASHINGTON DC
20036-2827
US

IV. Provider business mailing address

1717 N ST NW STE 1
WASHINGTON DC
20036-2827
US

V. Phone/Fax

Practice location:
  • Phone: 240-610-2423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCACII200001312
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN1049231
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: