Provider Demographics
NPI:1932796042
Name:BANGURA, RAKIATU ADAMA
Entity Type:Individual
Prefix:
First Name:RAKIATU
Middle Name:ADAMA
Last Name:BANGURA
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 1:275 RED CLAY RD APT 303
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2369
Mailing Address - Country:US
Mailing Address - Phone:202-790-8903
Mailing Address - Fax:301-889-9735
Practice Address - Street 1:275 RED CLAY RD APT 303
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2369
Practice Address - Country:US
Practice Address - Phone:202-790-8903
Practice Address - Fax:301-889-9735
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician