MEDICARE: MRS. FELICITAS TAKANG AYUK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1538839543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FELICITAS TAKANG AYUK

Provider Business Mailing Address
First Line	:	6422 LANDING WAY
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-4619
Country	:	US
Telephone Number	:	240-593-8704
Fax Number	:

Provider Business Practice Location Address
First Line	:	6422 LANDING WAY
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-4619
Country	:	US
Telephone Number	:	240-593-8704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	09/20/2021

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