Provider Demographics
NPI:1972291276
Name:MALANGA, WINNIE LUSICHE
Entity type:Individual
Prefix:
First Name:WINNIE
Middle Name:LUSICHE
Last Name:MALANGA
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 1:4220 RALEIGH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-5379
Mailing Address - Country:US
Mailing Address - Phone:703-887-9118
Mailing Address - Fax:
Practice Address - Street 1:609 HARBOR SIDE ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-5419
Practice Address - Country:US
Practice Address - Phone:703-896-0760
Practice Address - Fax:703-345-2526
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician