Provider Demographics
NPI:1194402008
Name:EPSE JABUT, CHANTAL TIFUH ACHA
Entity type:Individual
Prefix:
First Name:CHANTAL TIFUH
Middle Name:ACHA
Last Name:EPSE JABUT
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 1:6606 RYCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3652
Mailing Address - Country:US
Mailing Address - Phone:518-249-7889
Mailing Address - Fax:
Practice Address - Street 1:3921 MINNESOTA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2662
Practice Address - Country:US
Practice Address - Phone:202-924-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
DC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator