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General NPI Number Information
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NPI Number | 1427911759
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Entity Type | Individual
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Provider Name | ELVIS CLINCE KANTCHOUET FONGANG SR.
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Gender | Male
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 3504 COMMODORE JOSHUA BARNEY DR NE APT 302
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City | WASHINGTON
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State | DC
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Zip | 20018-4406
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Country | US
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Telephone | 301-326-8934
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Fax |
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Provider Business Mailing Address
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Address Line | 3504 COMMODORE JOSHUA BARNEY DR NE APT 302
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City | WASHINGTON
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State | DC
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Zip | 20018-4406
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Country | US
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Telephone | 301-326-8934
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | A00225562
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License Number State | DC
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