Organization
KENAH ONE HEALTH CARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KETTY NGONA CRNP, PMH-BC (PROGRAM DIRECTOR)
(443) 465-9958
Entity
Organization
Contact information
Practice address
308 CRAIN HWY N, GLEN BURNIE, MD 21061-3090
(443) 465-9958
Mailing address
7735 HOLLINS CHAPEL CT, GLEN BURNIE, MD 21060-8396
(443) 465-9958
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
04/29/2020
Last updated
11/29/2021
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