Provider Demographics
NPI:1043584105
Name:ONIANWA, ODIKPO OKELEKE (MSW INERN)
Entity Type:Individual
Prefix:
First Name:ODIKPO
Middle Name:OKELEKE
Last Name:ONIANWA
Suffix:
Gender:M
Credentials:MSW INERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 E PALMDALE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-2028
Mailing Address - Country:US
Mailing Address - Phone:661-483-7312
Mailing Address - Fax:
Practice Address - Street 1:1529 E PALMDALE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2028
Practice Address - Country:US
Practice Address - Phone:661-483-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW97928101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor