Healthcare Provider Details

I. General information

NPI: 1780599597
Provider Name (Legal Business Name): FRIDAOUS BIENVENUE DJOBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 CORPORATE CT
ELLICOTT CITY MD
21042-2247
US

IV. Provider business mailing address

6000 MERRIWEATHER DR UNIT 3023
COLUMBIA MD
21044-4180
US

V. Phone/Fax

Practice location:
  • Phone: 410-988-5427
  • Fax:
Mailing address:
  • Phone: 202-459-1843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number35244
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: