Provider Demographics
NPI:1003432634
Name:EWHAREKUKO, ERIYOMA (LCSWA)
Entity Type:Individual
Prefix:
First Name:ERIYOMA
Middle Name:
Last Name:EWHAREKUKO
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:REMI
Other - Middle Name:
Other - Last Name:EWHAREKUKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWA
Mailing Address - Street 1:1339 BRIAR CREEK RD APT 7
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-8222
Mailing Address - Country:US
Mailing Address - Phone:314-255-5907
Mailing Address - Fax:
Practice Address - Street 1:1339 BRIAR CREEK RD APT 7
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-8222
Practice Address - Country:US
Practice Address - Phone:314-255-5907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0145351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty