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General NPI Number Information
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NPI Number | 1063197507
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Entity Type | Individual
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Provider Name | GUI IT WOUATOUO
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Gender | Male
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 1427 GOOD HOPE RD SE
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City | WASHINGTON
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State | DC
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Zip | 20020-5614
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Country | US
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Telephone | 240-440-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 13633 WATER FOWL WAY
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-7115
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Country | US
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Telephone | 240-440-2550
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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