Provider Demographics
NPI:1437988185
Name:TANIFUM, ROLAND AYUHMBI
Entity type:Individual
Prefix:
First Name:ROLAND
Middle Name:AYUHMBI
Last Name:TANIFUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 CROOKED CREEK CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3185
Mailing Address - Country:US
Mailing Address - Phone:540-394-8316
Mailing Address - Fax:
Practice Address - Street 1:9707 EVENING PRIMROSE DR APT 1C
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-6322
Practice Address - Country:US
Practice Address - Phone:540-394-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health