Provider Demographics
NPI:1073299178
Name:EUGINE-NKENGBEZA, ATEM NKENGBEZA
Entity Type:Individual
Prefix:
First Name:ATEM
Middle Name:NKENGBEZA
Last Name:EUGINE-NKENGBEZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 FAIRHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5308
Mailing Address - Country:US
Mailing Address - Phone:240-708-3988
Mailing Address - Fax:
Practice Address - Street 1:9100 FAIRHAVEN AVE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5308
Practice Address - Country:US
Practice Address - Phone:240-708-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health