Healthcare Provider Details

I. General information

NPI: 1376237669
Provider Name (Legal Business Name): DAVID NTUNGWO ATABONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 BLADENSBURG RD NE
WASHINGTON DC
20002-2922
US

IV. Provider business mailing address

12613 MARLTON CENTER DR
UPPER MARLBORO MD
20772-5104
US

V. Phone/Fax

Practice location:
  • Phone: 202-507-8139
  • Fax:
Mailing address:
  • Phone: 202-993-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC200012667
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: