Provider Demographics
NPI:1457730772
Name:MBILISHAKA, AFIYA MANGUM (PHD)
Entity type:Individual
Prefix:DR
First Name:AFIYA
Middle Name:MANGUM
Last Name:MBILISHAKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AFIYA
Other - Middle Name:MIRIAM
Other - Last Name:MANGUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3300 E WEST HWY
Mailing Address - Street 2:APT 355
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2176
Mailing Address - Country:US
Mailing Address - Phone:516-238-7333
Mailing Address - Fax:
Practice Address - Street 1:1115 MASSACHUSETTS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4604
Practice Address - Country:US
Practice Address - Phone:516-238-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000845103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical