Provider Demographics
NPI:1760721856
Name:MUALUKO, MWENDE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MWENDE
Middle Name:
Last Name:MUALUKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 GREENSBORO DR APT 910
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-7377
Mailing Address - Country:US
Mailing Address - Phone:404-414-8600
Mailing Address - Fax:
Practice Address - Street 1:8280 WILLOW OAKS CORPORATE DR STE 600
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4516
Practice Address - Country:US
Practice Address - Phone:703-634-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-2167103TC0700X
UT9374624-2501103TC0700X
VA0810005824103TC0700X
WAPY60278819103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical