Provider Demographics
NPI:1295445518
Name:KWATI AYONG, MUBONGO PRIESTLY
Entity type:Individual
Prefix:
First Name:MUBONGO
Middle Name:PRIESTLY
Last Name:KWATI AYONG
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 1:1403 WHOOPING CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7086
Mailing Address - Country:US
Mailing Address - Phone:202-459-3794
Mailing Address - Fax:
Practice Address - Street 1:1403 WHOOPING CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-7086
Practice Address - Country:US
Practice Address - Phone:202-459-3794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health