Healthcare Provider Details

I. General information

NPI: 1245591874
Provider Name (Legal Business Name): YAYA ABANGMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 LIVINGSTON RD SE
WASHINGTON DC
20032-3136
US

IV. Provider business mailing address

4311 REGALWOOD TER
BURTONSVILLE MD
20866-2214
US

V. Phone/Fax

Practice location:
  • Phone: 202-562-0391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: