Provider Demographics
NPI:1063561355
Name:LODONOU, PROSPER
Entity type:Individual
Prefix:MR
First Name:PROSPER
Middle Name:
Last Name:LODONOU
Suffix:
Gender:M
Credentials:
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:WATTA
Other - Last Name:SAYGBE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4754 KENMORE AVE
Mailing Address - Street 2:APT. #203
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1246
Mailing Address - Country:US
Mailing Address - Phone:703-586-0539
Mailing Address - Fax:
Practice Address - Street 1:4754 KENMORE AVE
Practice Address - Street 2:APT. #203
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1246
Practice Address - Country:US
Practice Address - Phone:703-586-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health