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General NPI Number Information
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NPI Number | 1023514213
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Entity Type | Organization
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Legal Business Name | IJOMAH AND ASSOCIATES INC
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 4607 69TH AVE
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City | HYATTSVILLE
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State | MD
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Zip | 20784-2123
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Country | US
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Telephone | 301-821-1671
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Fax |
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Provider Business Mailing Address
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Address Line | 4607 69TH AVE
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City | HYATTSVILLE
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State | MD
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Zip | 20784-2123
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | BEN IJOMAH
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Credential |
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Telephone | 301-821-1671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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