Healthcare Provider Details

I. General information

NPI: 1659146124
Provider Name (Legal Business Name): LENA LOIS DETCHOUA TCHAMACO LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20410 OBSERVATION DR STE 212
GERMANTOWN MD
20876-4068
US

IV. Provider business mailing address

9301 ANNAPOLIS RD
LANHAM MD
20706-3115
US

V. Phone/Fax

Practice location:
  • Phone: 240-296-6353
  • Fax:
Mailing address:
  • Phone: 855-324-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP17106
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: