Healthcare Provider Details

I. General information

NPI: 1487103123
Provider Name (Legal Business Name): CAROLE TCHAKOUNTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MISSOURI AVE NW
WASHINGTON DC
20011-5113
US

IV. Provider business mailing address

2759 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032-2646
US

V. Phone/Fax

Practice location:
  • Phone: 202-361-3203
  • Fax:
Mailing address:
  • Phone: 202-563-8690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA11973
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: