Provider Demographics
NPI:1679281513
Name:JAWARA, MARIAMA
Entity type:Individual
Prefix:
First Name:MARIAMA
Middle Name:
Last Name:JAWARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 N CAPITOL ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3360
Mailing Address - Country:US
Mailing Address - Phone:202-800-4387
Mailing Address - Fax:
Practice Address - Street 1:1511 KINGSGATE ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2033
Practice Address - Country:US
Practice Address - Phone:240-408-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC171M00000X
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ600585009244OtherDL
MDJ600585009244OtherDRIVERS LISEAN