Provider Demographics
NPI:1194399931
Name:OGHENEGWEKE, LATOYA LYNN
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:LYNN
Last Name:OGHENEGWEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:LYNN
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2519 JOHN EPPES RD APT 302
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4402
Mailing Address - Country:US
Mailing Address - Phone:571-298-5210
Mailing Address - Fax:
Practice Address - Street 1:2519 JOHN EPPES RD APT 302
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4402
Practice Address - Country:US
Practice Address - Phone:571-298-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst