Healthcare Provider Details

I. General information

NPI: 1508440090
Provider Name (Legal Business Name): NTIZEAH KINGSLEY AKAH JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 85TH AVE
LANHAM MD
20706-4504
US

IV. Provider business mailing address

5405 85TH AVE
LANHAM MD
20706-4504
US

V. Phone/Fax

Practice location:
  • Phone: 240-305-5259
  • Fax:
Mailing address:
  • Phone: 240-305-5259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberHHA15740
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: