Provider Demographics
NPI:1053972869
Name:DIAKITE, CHEICK OUMAR
Entity type:Individual
Prefix:
First Name:CHEICK
Middle Name:OUMAR
Last Name:DIAKITE
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 1:80 M ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3544
Mailing Address - Country:US
Mailing Address - Phone:240-645-9583
Mailing Address - Fax:
Practice Address - Street 1:80 M ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3544
Practice Address - Country:US
Practice Address - Phone:240-645-9583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD832427314Medicaid