Provider Demographics
NPI:1861197659
Name:TCHUISSI DALE, HERVE ROMARIE
Entity type:Individual
Prefix:
First Name:HERVE
Middle Name:ROMARIE
Last Name:TCHUISSI DALE
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 1:19929 SWEETGUM CIR APT 43
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3785
Mailing Address - Country:US
Mailing Address - Phone:240-565-9237
Mailing Address - Fax:
Practice Address - Street 1:19929 SWEETGUM CIR APT 43
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-3785
Practice Address - Country:US
Practice Address - Phone:240-565-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health