Provider Demographics
NPI:1801590401
Name:LEMOUPA, DESIRE
Entity type:Individual
Prefix:
First Name:DESIRE
Middle Name:
Last Name:LEMOUPA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5413 SHERIFF RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1411
Mailing Address - Country:US
Mailing Address - Phone:240-770-7994
Mailing Address - Fax:
Practice Address - Street 1:2918 MINNESOTA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1127
Practice Address - Country:US
Practice Address - Phone:240-870-0037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC172V00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker