Provider Demographics
NPI:1922794122
Name:TEZI, NEIVILLE AGHANDUM JR
Entity Type:Individual
Prefix:MR
First Name:NEIVILLE
Middle Name:AGHANDUM
Last Name:TEZI
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 1:6715 LAMONT DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3734
Mailing Address - Country:US
Mailing Address - Phone:240-487-8072
Mailing Address - Fax:
Practice Address - Street 1:6715 LAMONT DR
Practice Address - Street 2:
Practice Address - City:2041 MLK JR. AVE SE, SUITE
Practice Address - State:DC
Practice Address - Zip Code:20020
Practice Address - Country:US
Practice Address - Phone:240-487-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health