Provider Demographics
NPI:1295385532
Name:UKO, ALICE MFON
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:MFON
Last Name:UKO
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 1:14023 CASTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4715
Mailing Address - Country:US
Mailing Address - Phone:240-305-5860
Mailing Address - Fax:
Practice Address - Street 1:14023 CASTLE BLVD APT 401
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4791
Practice Address - Country:US
Practice Address - Phone:240-305-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22352104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker