Provider Demographics
NPI:1982878591
Name:KAYONGA, VERONICA GRIFFIN
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:GRIFFIN
Last Name:KAYONGA
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 1:462 ARLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-7270
Mailing Address - Country:US
Mailing Address - Phone:904-254-8992
Mailing Address - Fax:904-743-4732
Practice Address - Street 1:462 ARLINGTON PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-1550
Practice Address - Country:US
Practice Address - Phone:904-254-8992
Practice Address - Fax:904-743-4732
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL76653598Medicaid
FL766653500Medicaid
FL766653596Medicaid