Provider Demographics
NPI:1215505953
Name:YMELE, ZEBAZE ELSSA KENFACK
Entity type:Individual
Prefix:
First Name:ZEBAZE
Middle Name:ELSSA KENFACK
Last Name:YMELE
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 1:6305 IVY LN
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1465
Mailing Address - Country:US
Mailing Address - Phone:202-790-8903
Mailing Address - Fax:
Practice Address - Street 1:2275 RESEARCH BLVD STE 500
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6203
Practice Address - Country:US
Practice Address - Phone:240-428-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11817101YP2500X
MDRBT-21-171569106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician