=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548931942
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. GERARD NGUEDI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2021
-----------------------------------------------------
Last Update Date | 09/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7017 DASHER FARM CT
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-8207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-744-7802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 584
-----------------------------------------------------
City | WASHINGTON GROVE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20880-0584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-744-7802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6881
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6881
-----------------------------------------------------
License Number State |
-----------------------------------------------------