Provider Demographics
NPI:1548067382
Name:NJILIFAC EPSE NDASEH, QUEENDOLINE
Entity type:Individual
Prefix:
First Name:QUEENDOLINE
Middle Name:
Last Name:NJILIFAC EPSE NDASEH
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 1:3207 LAUREL HILL RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2256
Mailing Address - Country:US
Mailing Address - Phone:240-887-2649
Mailing Address - Fax:
Practice Address - Street 1:3207 LAUREL HILL RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-2256
Practice Address - Country:US
Practice Address - Phone:240-887-2649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty