Healthcare Provider Details

I. General information

NPI: 1881276723
Provider Name (Legal Business Name): SERGE ASONGLEFACK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE
WASHINGTON DC
20002-1848
US

IV. Provider business mailing address

13300 BRIARWOOD DR
LAUREL MD
20708-1408
US

V. Phone/Fax

Practice location:
  • Phone: 703-940-7378
  • Fax:
Mailing address:
  • Phone: 703-940-7378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: