Provider Demographics
NPI:1114731791
Name:AGHA NFON, CLOVIS
Entity type:Individual
Prefix:
First Name:CLOVIS
Middle Name:
Last Name:AGHA NFON
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 1:6200 WESTCHESTER PARK DR APT 520
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2837
Mailing Address - Country:US
Mailing Address - Phone:202-607-7110
Mailing Address - Fax:
Practice Address - Street 1:3109 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1573
Practice Address - Country:US
Practice Address - Phone:202-609-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker