Healthcare Provider Details

I. General information

NPI: 1730784398
Provider Name (Legal Business Name): CHIVIC HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 ANNAPOLIS RD STE 416
LANHAM MD
20706-3000
US

IV. Provider business mailing address

9470 ANNAPOLIS RD STE 416
LANHAM MD
20706-3000
US

V. Phone/Fax

Practice location:
  • Phone: 202-735-1010
  • Fax:
Mailing address:
  • Phone: 202-735-1010
  • Fax: 202-567-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. NDIDIAMAKA EZINNE MBAKPUO
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 301-712-4637