Healthcare Provider Details

I. General information

NPI: 1265373500
Provider Name (Legal Business Name): CEDRIC TEZEH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10308 VISTA SOLA WAY
LANHAM MD
20706-2968
US

IV. Provider business mailing address

10308 VISTA SOLA WAY
LANHAM MD
20706-2968
US

V. Phone/Fax

Practice location:
  • Phone: 240-872-7168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: