Healthcare Provider Details

I. General information

NPI: 1700762556
Provider Name (Legal Business Name): ALES EKWET TAMBE ACHUO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 SOUTHERN AVE
CAPITOL HEIGHTS MD
20743-5639
US

IV. Provider business mailing address

9963 GOOD LUCK RD APT 103
LANHAM MD
20706-3274
US

V. Phone/Fax

Practice location:
  • Phone: 256-951-0225
  • Fax:
Mailing address:
  • Phone: 256-951-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: