Individual
HOLY MBAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6305 61ST PL, RIVERDALE, MD 20737-1408
(202) 560-0475
Mailing address
6305 61ST PL, RIVERDALE, MD 20737-1408
(202) 560-0475
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
11/17/2022
Last updated
06/01/2023
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