Provider Demographics
NPI:1104188796
Name:TCHOUAGA, LITICIA TCHOKO
Entity Type:Individual
Prefix:
First Name:LITICIA
Middle Name:TCHOKO
Last Name:TCHOUAGA
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 1:1704 HAMPSHIRE GREEN LN APT 23
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2412
Mailing Address - Country:US
Mailing Address - Phone:240-422-4484
Mailing Address - Fax:
Practice Address - Street 1:1704 HAMPSHIRE GREEN LN APT 23
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2412
Practice Address - Country:US
Practice Address - Phone:240-422-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT-220-522-787-942374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide