Provider Demographics
NPI:1477359842
Name:CHERIF, MOUSSA TAMBA III
Entity type:Individual
Prefix:MR
First Name:MOUSSA
Middle Name:TAMBA
Last Name:CHERIF
Suffix:III
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21714 SENECA AYR DR
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-2006
Mailing Address - Country:US
Mailing Address - Phone:240-778-7447
Mailing Address - Fax:
Practice Address - Street 1:21714 SENECA AYR DR
Practice Address - Street 2:
Practice Address - City:BOYDS
Practice Address - State:MD
Practice Address - Zip Code:20841-2006
Practice Address - Country:US
Practice Address - Phone:240-778-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health