Provider Demographics
NPI:1508440090
Name:AKAH, NTIZEAH KINGSLEY JR
Entity Type:Individual
Prefix:
First Name:NTIZEAH
Middle Name:KINGSLEY
Last Name:AKAH
Suffix:JR
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 1:5405 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4504
Mailing Address - Country:US
Mailing Address - Phone:240-305-5259
Mailing Address - Fax:
Practice Address - Street 1:5405 85TH AVE
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4504
Practice Address - Country:US
Practice Address - Phone:240-305-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15740101YM0800X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty