Provider Demographics
NPI:1386166445
Name:GAKEH, MARENCIA ABUNJUNG
Entity type:Individual
Prefix:
First Name:MARENCIA
Middle Name:ABUNJUNG
Last Name:GAKEH
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 1:6713 TERRA ALTA DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3747
Mailing Address - Country:US
Mailing Address - Phone:240-645-8022
Mailing Address - Fax:
Practice Address - Street 1:9030 RED BRANCH RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2003
Practice Address - Country:US
Practice Address - Phone:877-504-4141
Practice Address - Fax:703-348-3267
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-20-117473106S00000X
MD1-24-74396103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician