Provider Demographics
NPI:1518563964
Name:NWANGUMA, FLINT
Entity Type:Individual
Prefix:
First Name:FLINT
Middle Name:
Last Name:NWANGUMA
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 1:222 MILFORD MILL RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6000
Mailing Address - Country:US
Mailing Address - Phone:443-613-2567
Mailing Address - Fax:410-602-8449
Practice Address - Street 1:222 MILFORD MILL RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6000
Practice Address - Country:US
Practice Address - Phone:443-613-2567
Practice Address - Fax:410-602-8449
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD83-3900711Medicaid