Individual
BONIFACE LEBOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2508 BROOKE GROVE RD, BOWIE, MD 20721-1885
(202) 894-6811
Mailing address
2508 BROOKE GROVE RD, BOWIE, MD 20721-1885
(240) 886-7978
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
07/11/2023
Last updated
07/21/2023
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