Provider Demographics
NPI:1891183711
Name:HONGOLA, STELLA (PSYD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:HONGOLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4410
Mailing Address - Country:US
Mailing Address - Phone:202-390-0489
Mailing Address - Fax:
Practice Address - Street 1:12073 TECH ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:240-691-4953
Practice Address - Fax:301-681-4699
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017473103T00000X
MD05369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist