Provider Demographics
NPI:1962763599
Name:NJILA DEBALOU, VICTORINE CHANTAL N
Entity type:Individual
Prefix:
First Name:VICTORINE CHANTAL
Middle Name:N
Last Name:NJILA DEBALOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20116 ASHBROOK PL STE 100
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3445
Mailing Address - Country:US
Mailing Address - Phone:517-291-9752
Mailing Address - Fax:
Practice Address - Street 1:20116 ASHBROOK PL STE 100
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3445
Practice Address - Country:US
Practice Address - Phone:571-291-9752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator