Provider Demographics
NPI:1093528085
Name:TEBID, VIVIAN ABONG
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:ABONG
Last Name:TEBID
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 1:4512 DOCTOR BEANS LEGACY CIR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6384
Mailing Address - Country:US
Mailing Address - Phone:202-560-3814
Mailing Address - Fax:
Practice Address - Street 1:4512 DOCTOR BEANS LEGACY CIR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-6384
Practice Address - Country:US
Practice Address - Phone:202-560-3814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker