Provider Demographics
NPI:1760161236
Name:ENYINNAYA, JUSTICE C
Entity Type:Individual
Prefix:
First Name:JUSTICE
Middle Name:C
Last Name:ENYINNAYA
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 1:9314 SPRING HOUSE LN APT J
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3257
Mailing Address - Country:US
Mailing Address - Phone:202-304-5217
Mailing Address - Fax:
Practice Address - Street 1:4720 BOSTON WAY STE D
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6327
Practice Address - Country:US
Practice Address - Phone:301-918-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator