Provider Demographics
NPI:1295413581
Name:KANGSEN, ABOHWEN FAITHFUL MBI
Entity type:Individual
Prefix:
First Name:ABOHWEN
Middle Name:FAITHFUL MBI
Last Name:KANGSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10602 LAKE ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3135
Mailing Address - Country:US
Mailing Address - Phone:240-595-8755
Mailing Address - Fax:
Practice Address - Street 1:10602 LAKE ARBOR WAY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3135
Practice Address - Country:US
Practice Address - Phone:240-595-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health