Individual
DIVINE FOMBU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSW
Contact information
Practice address
13817 BRIARWOOD DR APT 1123, LAUREL, MD 20708-1345
(240) 476-3253
Mailing address
1706 HAMPSHIRE GREEN LN, SILVER SPRING, MD 20903-2416
(202) 545-0935
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/09/2012
Last updated
12/13/2023
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