Provider Demographics
NPI:1427911759
Name:KANTCHOUET FONGANG, ELVIS CLINCE SR
Entity type:Individual
Prefix:
First Name:ELVIS CLINCE
Middle Name:
Last Name:KANTCHOUET FONGANG
Suffix:SR
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 1:3504 COMMODORE JOSHUA BARNEY DR NE APT 302
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-4406
Mailing Address - Country:US
Mailing Address - Phone:301-326-8934
Mailing Address - Fax:
Practice Address - Street 1:3504 COMMODORE JOSHUA BARNEY DR NE APT 302
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4406
Practice Address - Country:US
Practice Address - Phone:301-326-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-04
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCA00225562101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral