Provider Demographics
NPI:1023379898
Name:ASONGAKAP, NICOLINE BEBONGCHU
Entity Type:Individual
Prefix:
First Name:NICOLINE
Middle Name:BEBONGCHU
Last Name:ASONGAKAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 CRETIA PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5787
Mailing Address - Country:US
Mailing Address - Phone:240-701-0704
Mailing Address - Fax:
Practice Address - Street 1:5919 CHERRYWOOD TER
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3145
Practice Address - Country:US
Practice Address - Phone:240-701-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB152630003990374U00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No374U00000XNursing Service Related ProvidersHome Health Aide