Basic Information
| Provider Information | |||||||||
| NPI: | 1871927079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NDICHU | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | WANJAMAH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11700 OLD COLUMBIA PIKE | ||||||||
| Address2: | APT 2019 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209042579 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6525 BELCREST RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HYATTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207822003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017798345 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2013 | ||||||||
| LastUpdateDate: | 08/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LC50079764 | DC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.