Provider Demographics
NPI:1740942291
Name:WEREBESSI, MARCELINE ENJEI
Entity type:Individual
Prefix:
First Name:MARCELINE
Middle Name:ENJEI
Last Name:WEREBESSI
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 1:13906 BRIARWOOD DR APT 2322
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1334
Mailing Address - Country:US
Mailing Address - Phone:240-564-7056
Mailing Address - Fax:
Practice Address - Street 1:13906 BRIARWOOD DR APT 2322
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1334
Practice Address - Country:US
Practice Address - Phone:240-564-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 171400000X
DCHHA200001466374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide