Provider Demographics
NPI:1558066084
Name:MONGO DJOPGANG, JAMES PETERSON
Entity Type:Individual
Prefix:MR
First Name:JAMES PETERSON
Middle Name:
Last Name:MONGO DJOPGANG
Suffix:
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 1:13920 CASTLE BLVD APT 606
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4959
Mailing Address - Country:US
Mailing Address - Phone:301-760-6165
Mailing Address - Fax:
Practice Address - Street 1:13920 CASTLE BLVD APT 606
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4959
Practice Address - Country:US
Practice Address - Phone:301-760-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical