Healthcare Provider Details

I. General information

NPI: 1548197429
Provider Name (Legal Business Name): EMILE ZOLA BOUMA BOUMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

702 15TH ST NE
WASHINGTON DC
20002-4508
US

IV. Provider business mailing address

7714 TINKERS CREEK DR
CLINTON MD
20735-1477
US

V. Phone/Fax

Practice location:
  • Phone: 202-847-3218
  • Fax:
Mailing address:
  • Phone: 202-710-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: