Provider Demographics
NPI:1063015261
Name:HENRY-AJUDUA, VIVIAN ONYEBUCHI (APRN/PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:ONYEBUCHI
Last Name:HENRY-AJUDUA
Suffix:
Gender:F
Credentials:APRN/PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 CORAL DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-3132
Mailing Address - Country:US
Mailing Address - Phone:919-949-4351
Mailing Address - Fax:
Practice Address - Street 1:117 HIDDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-8949
Practice Address - Country:US
Practice Address - Phone:919-896-6998
Practice Address - Fax:919-896-6998
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2738962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry