Provider Demographics
NPI:1477258853
Name:NEBA, ABEINWU AMBESI
Entity Type:Individual
Prefix:MR
First Name:ABEINWU
Middle Name:AMBESI
Last Name:NEBA
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 1:5106 CHESHIRE LN
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4165
Mailing Address - Country:US
Mailing Address - Phone:240-828-9571
Mailing Address - Fax:
Practice Address - Street 1:5106 CHESHIRE LN
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4165
Practice Address - Country:US
Practice Address - Phone:240-828-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD-10272361905104100000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No104100000XBehavioral Health & Social Service ProvidersSocial Worker