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General NPI Number Information
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NPI Number | 1629505367
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Entity Type | Individual
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Provider Name | CARLLISTUS OBENG M.ED
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Gender | Male
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 6200 KANSAS AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20011-1508
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Country | US
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Telephone | 202-722-4421
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Fax |
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Provider Business Mailing Address
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Address Line | 8671 HAYSHED LN
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City | COLUMBIA
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State | MD
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Zip | 21045-2620
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Country | US
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Telephone | 410-908-1365
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | DC
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