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1891051413
DIVINE FOMBU
LAUREL, MD
NPI
1891051413
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2012-04-09
Last Update Date
2023-12-13
Business Address
DIVINE FOMBU CSW
13817 BRIARWOOD DR APT 1123
LAUREL, MD 20708-1345
Phone number: 240-476-3253
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Mailing Address
DIVINE FOMBU CSW
1706 HAMPSHIRE GREEN LN
SILVER SPRING, MD 20903-2416
Phone number: 202-545-0935
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