Healthcare Provider Details

I. General information

NPI: 1962394916
Provider Name (Legal Business Name): EJOBI TOKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 MINNESOTA AVE SE
WASHINGTON DC
20019-1127
US

IV. Provider business mailing address

16615 TELESCOPE LN
DUMFRIES VA
22026-2193
US

V. Phone/Fax

Practice location:
  • Phone: 641-680-4714
  • Fax:
Mailing address:
  • Phone: 641-680-4714
  • Fax: 641-680-4714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: