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General NPI Number Information
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NPI Number | 1952022238
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Entity Type | Organization
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Legal Business Name | FUBE ENTERPRISES, LLC
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 8210 JEREMIAH LN
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City | COLUMBIA
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State | MD
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Zip | 21044-4165
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Country | US
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Telephone | 443-230-2285
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Fax | 301-368-6675
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Provider Business Mailing Address
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Address Line | 8210 JEREMIAH LN
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City | COLUMBIA
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State | MD
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Zip | 21044-4165
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Country | US
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Telephone | 443-230-2285
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Fax | 301-368-6675
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. NGUFOR FUBE DIVINE
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Credential | CRNP-PMH
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Telephone | 443-230-2285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 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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