Provider Demographics
NPI:1336902667
Name:LYONGA, VICTORY EWELISANE
Entity Type:Individual
Prefix:
First Name:VICTORY
Middle Name:EWELISANE
Last Name:LYONGA
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 1:7802 TALLINN CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4490
Mailing Address - Country:US
Mailing Address - Phone:240-778-7155
Mailing Address - Fax:
Practice Address - Street 1:2241 MARTIN LUTHER KING JR AVE
Practice Address - Street 2:
Practice Address - City:DC
Practice Address - State:DC
Practice Address - Zip Code:20003
Practice Address - Country:US
Practice Address - Phone:202-809-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator