Provider Demographics
NPI:1093583882
Name:GODBLESS, FAVOUR CHUKWUEBUKA
Entity Type:Individual
Prefix:
First Name:FAVOUR
Middle Name:CHUKWUEBUKA
Last Name:GODBLESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14135 CERISE AVE APT 121
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-8494
Mailing Address - Country:US
Mailing Address - Phone:323-392-2295
Mailing Address - Fax:
Practice Address - Street 1:1051 ELECTRIC ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3344
Practice Address - Country:US
Practice Address - Phone:510-364-1783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst