Provider Demographics
NPI:1033393202
Name:NWOGWUGWU, STANLEY I (MA, LCPC)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:I
Last Name:NWOGWUGWU
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 S CHARLES ST STE 140
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2477
Mailing Address - Country:US
Mailing Address - Phone:443-873-7197
Mailing Address - Fax:443-873-7198
Practice Address - Street 1:575 S CHARLES ST STE 140
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2477
Practice Address - Country:US
Practice Address - Phone:443-873-7197
Practice Address - Fax:443-873-7198
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA1914101YA0400X
MDLC2385101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)