Healthcare Provider Details

I. General information

NPI: 1962052878
Provider Name (Legal Business Name): CHINITA MONE'E COLBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date: 04/18/2023
Reactivation Date: 05/02/2023

III. Provider practice location address

2905 MITCHELLVILLE RD STE 204
BOWIE MD
20716-3961
US

IV. Provider business mailing address

5230 TUCKERMAN LN APT 922
NORTH BETHESDA MD
20852-3862
US

V. Phone/Fax

Practice location:
  • Phone: 301-701-6965
  • Fax:
Mailing address:
  • Phone: 301-213-8347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP13769
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC200001511
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: