Healthcare Provider Details

I. General information

NPI: 1861325276
Provider Name (Legal Business Name): COMMUNITY OF CARE MENTAL HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4743 RIVER VALLEY WAY
BOWIE MD
20720-3433
US

IV. Provider business mailing address

4743 RIVER VALLEY WAY
BOWIE MD
20720-3433
US

V. Phone/Fax

Practice location:
  • Phone: 301-222-7015
  • Fax: 301-222-7015
Mailing address:
  • Phone: 301-222-7015
  • Fax: 301-222-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. BERENICE MUMBEMSA NGAM
Title or Position: PMHNP
Credential: DNP
Phone: 301-222-7015