Provider Demographics
NPI:1114577608
Name:SONGONUGA, VICTORIA (LCPC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SONGONUGA
Suffix:
Gender:U
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 YORK RD STE 800
Mailing Address - Street 2:#1052
Mailing Address - City:LUTHERVILLE-TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2035
Mailing Address - Country:US
Mailing Address - Phone:443-436-2471
Mailing Address - Fax:
Practice Address - Street 1:1301 YORK RD STE 800
Practice Address - Street 2:#1052
Practice Address - City:LUTHERVILLE-TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2035
Practice Address - Country:US
Practice Address - Phone:443-436-2471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2024-11-05
Deactivation Date:2022-10-11
Deactivation Code:
Reactivation Date:2024-11-05
Provider Licenses
StateLicense IDTaxonomies
MDLC15772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty