Individual
FIDELIS N SAB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAC II
Contact information
Practice address
3109 MARTIN LUTHER KING JR AVE SE, WASHINGTON, DC 20032-1573
(202) 800-4433
Mailing address
7903 ORION CIR APT C215, LAUREL, MD 20724-3101
(240) 350-9677
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CACII200001262
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
05/16/2012
Last updated
03/25/2026
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