Provider Demographics
NPI:1740705508
Name:YOLANDE, AWENDONG EKWAINGEN
Entity type:Individual
Prefix:
First Name:AWENDONG
Middle Name:EKWAINGEN
Last Name:YOLANDE
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 1:5710 CYPRESS CREEK DR APT 201
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1816
Mailing Address - Country:US
Mailing Address - Phone:240-790-6575
Mailing Address - Fax:
Practice Address - Street 1:5710 CYPRESS CREEK DR APT 201
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1816
Practice Address - Country:US
Practice Address - Phone:240-790-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13017374U00000X
WAHHA13017101YS0200X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDY453076199681Medicaid