Healthcare Provider Details

I. General information

NPI: 1255295523
Provider Name (Legal Business Name): DESMOND NSUTEBU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9923 GOOD LUCK RD
LANHAM MD
20706-3255
US

IV. Provider business mailing address

3224 MATTIE GREY LN
MELISSA TX
75454-9754
US

V. Phone/Fax

Practice location:
  • Phone: 240-505-4326
  • Fax:
Mailing address:
  • Phone: 202-820-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: