Provider Demographics
NPI:1053016873
Name:AGBOR, BISONG VALERY (CSW)
Entity type:Individual
Prefix:
First Name:BISONG
Middle Name:VALERY
Last Name:AGBOR
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:MR
Other - First Name:BISONG
Other - Middle Name:VALERY
Other - Last Name:AGBOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:9863 GOOD LUCK RD APT 3
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3225
Mailing Address - Country:US
Mailing Address - Phone:202-883-9490
Mailing Address - Fax:
Practice Address - Street 1:9863 GOOD LUCK RD APT 3
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3225
Practice Address - Country:US
Practice Address - Phone:202-883-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator