Provider Demographics
NPI:1578860227
Name:MENGISTE, PATSY WINONA (LGP)
Entity Type:Individual
Prefix:MS
First Name:PATSY
Middle Name:WINONA
Last Name:MENGISTE
Suffix:
Gender:F
Credentials:LGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11275 SOUTHERN MARYLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-9546
Mailing Address - Country:US
Mailing Address - Phone:180-049-1526
Mailing Address - Fax:
Practice Address - Street 1:11275 SOUTHERN MARYLAND BLVD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-9546
Practice Address - Country:US
Practice Address - Phone:180-049-1526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP3262101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor