Healthcare Provider Details

I. General information

NPI: 1053288993
Provider Name (Legal Business Name): MR. CHARLES MUMA SOMBONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11435 LOCKWOOD DR APT 104
SILVER SPRING MD
20904-2613
US

IV. Provider business mailing address

11435 LOCKWOOD DR APT 104
SILVER SPRING MD
20904-2613
US

V. Phone/Fax

Practice location:
  • Phone: 240-463-0163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: