Healthcare Provider Details

I. General information

NPI: 1841160488
Provider Name (Legal Business Name): YEBACAM HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE
WASHINGTON DC
20002-1848
US

IV. Provider business mailing address

1818 NEW YORK AVE NE
WASHINGTON DC
20002-1848
US

V. Phone/Fax

Practice location:
  • Phone: 301-379-8697
  • Fax:
Mailing address:
  • Phone: 301-379-8697
  • 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: MRS. GWENDOLINE WUBNYONGA TANKOH
Title or Position: MENTAL HEALTH COUNSELING
Credential:
Phone: 301-379-8697