Provider Demographics
NPI:1639856941
Name:NSECKE, SERGES ADOLPHE
Entity type:Individual
Prefix:
First Name:SERGES ADOLPHE
Middle Name:
Last Name:NSECKE
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 1:6315 WOOD POINTE DR
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-2107
Mailing Address - Country:US
Mailing Address - Phone:202-830-8642
Mailing Address - Fax:
Practice Address - Street 1:6315 WOOD POINTE DR
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-2107
Practice Address - Country:US
Practice Address - Phone:202-830-8642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
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