Provider Demographics
NPI:1295608677
Name:TITA, NGWENYI
Entity type:Individual
Prefix:
First Name:NGWENYI
Middle Name:
Last Name:TITA
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 1:6926 ANDERSONS WAY APT 102
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5279
Mailing Address - Country:US
Mailing Address - Phone:402-202-0016
Mailing Address - Fax:
Practice Address - Street 1:6926 ANDERSONS WAY APT 102
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5279
Practice Address - Country:US
Practice Address - Phone:402-202-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
DC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No104100000XBehavioral Health & Social Service ProvidersSocial Worker