Healthcare Provider Details

I. General information

NPI: 1871927079
Provider Name (Legal Business Name): ERIC WANJAMAH NDICHU LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2013
Last Update Date: 09/06/2025
Certification Date: 09/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 SOLDIERS LN # PA
CORAOPOLIS PA
15108-2550
US

IV. Provider business mailing address

15005 ATHEY RD
BURTONSVILLE MD
20866-1645
US

V. Phone/Fax

Practice location:
  • Phone: 202-528-7137
  • Fax:
Mailing address:
  • Phone: 202-604-5681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014725
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079764
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17431
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: