Individual
DIVINE FOMBU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSW
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
04/09/2012
Last updated
05/18/2026
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