| Bonte Behavioral Health Services | |
|
8210 Jeremiah Ln Columbia MD 21044-4165 | |
| (443) 230-2285 | |
| (301) 368-6675 |
| Full Name | Bonte Behavioral Health Services |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 8210 Jeremiah Ln, Columbia, Maryland |
| Authorized Official Name and Position | Ngufor Fube Divine (PRESIDENT) |
| Authorized Official Contact | 4432302285 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bonte Behavioral Health Services 8210 Jeremiah Ln Columbia MD 21044-4165 Ph: (443) 230-2285 | Bonte Behavioral Health Services 8210 Jeremiah Ln Columbia MD 21044-4165 Ph: (443) 230-2285 |
| NPI Number | 1952022238 |
|---|---|
| Provider Enumeration Date | 09/06/2022 |
| Last Update Date | 07/26/2024 |
| Certification Date | 07/26/2024 |
| Medicare PECOS PAC ID | 3577932722 |
|---|---|
| Medicare Enrollment ID | O20221209000327 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952022238 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Ngufor Fube Divine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669197208 PECOS PAC ID: 1557767688 Enrollment ID: I20221209000420 |
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