Provider Demographics
NPI:1023203965
Name:NWOGU, AJUNWA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AJUNWA
Middle Name:
Last Name:NWOGU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:AJUU
Other - Middle Name:
Other - Last Name:NWOGU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:9332 ANNAPOLIS RD STE 303A
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3113
Mailing Address - Country:US
Mailing Address - Phone:240-241-0421
Mailing Address - Fax:
Practice Address - Street 1:9332 ANNAPOLIS RD STE 303A
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3113
Practice Address - Country:US
Practice Address - Phone:240-241-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
DCPSY1001160103T00000X
MD05049103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD589561800Medicaid