=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679478986
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAWANATU LATISHA BANGURA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2026
-----------------------------------------------------
Last Update Date | 10/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1440 N ST NW STE A1
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20005-2817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-645-5899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 SILVER SPRING AVE APT 626
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20910-5124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-645-5899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | 2855157
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------