Healthcare Provider Details

I. General information

NPI: 1235730870
Provider Name (Legal Business Name): NYAGA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 FLOWER AVE
TAKOMA PARK MD
20912-6425
US

IV. Provider business mailing address

7401 FLOWER AVE
TAKOMA PARK MD
20912-6425
US

V. Phone/Fax

Practice location:
  • Phone: 301-272-4912
  • Fax:
Mailing address:
  • Phone: 301-272-4912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAHMELA WILLIAMS
Title or Position: OWNER
Credential:
Phone: 301-272-4912