Provider Demographics
NPI:1376416990
Name:NDI, CLINTON CHICK
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:CHICK
Last Name:NDI
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 1:3254 GOSSETT CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3784
Mailing Address - Country:US
Mailing Address - Phone:202-300-6822
Mailing Address - Fax:
Practice Address - Street 1:3254 GOSSETT CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-3784
Practice Address - Country:US
Practice Address - Phone:202-300-6822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide