Provider Demographics
NPI:1023371812
Name:ABONGNELAH, PERPETUA
Entity Type:Individual
Prefix:
First Name:PERPETUA
Middle Name:
Last Name:ABONGNELAH
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 1:7826 EASTERN AVE NW
Mailing Address - Street 2:LL18A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1324
Mailing Address - Country:US
Mailing Address - Phone:202-722-7776
Mailing Address - Fax:202-722-7785
Practice Address - Street 1:7826 EASTERN AVE NW
Practice Address - Street 2:LL18A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1324
Practice Address - Country:US
Practice Address - Phone:202-722-7776
Practice Address - Fax:202-722-7785
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
23391104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker