Provider Demographics
NPI:1417659533
Name:SOUNA KENFACK, JEAN MAGLOIRE
Entity Type:Individual
Prefix:
First Name:JEAN MAGLOIRE
Middle Name:
Last Name:SOUNA KENFACK
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 1:4660 MARTIN LUTHER KING JR AVE SW STE A2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4933
Mailing Address - Country:US
Mailing Address - Phone:202-318-0719
Mailing Address - Fax:
Practice Address - Street 1:4660 MARTIN LUTHER KING JR AVE SW STE A2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4933
Practice Address - Country:US
Practice Address - Phone:202-318-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No251S00000XAgenciesCommunity/Behavioral Health