Provider Demographics
NPI:1205490653
Name:ALAGOA, SALLY
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:ALAGOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 EVERHART PL
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-3011
Mailing Address - Country:US
Mailing Address - Phone:301-257-0920
Mailing Address - Fax:
Practice Address - Street 1:5824 EVERHART PL
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-3011
Practice Address - Country:US
Practice Address - Phone:301-257-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities