Provider Demographics
NPI:1841899853
Name:MINGO, LONDON (LCSW)
Entity type:Individual
Prefix:
First Name:LONDON
Middle Name:
Last Name:MINGO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 563 BOX 7071
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96388-0071
Mailing Address - Country:US
Mailing Address - Phone:478-960-3040
Mailing Address - Fax:
Practice Address - Street 1:2769 YAKA KIN CHO
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96388-0071
Practice Address - Country:US
Practice Address - Phone:478-960-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW156551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical