Provider Demographics
NPI:1104377076
Name:AMARE, OBASI JAHEEM JR
Entity Type:Individual
Prefix:
First Name:OBASI
Middle Name:JAHEEM
Last Name:AMARE
Suffix:JR
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 1:5820 E W T HARRIS BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4032
Mailing Address - Country:US
Mailing Address - Phone:704-469-1243
Mailing Address - Fax:
Practice Address - Street 1:5820 E W T HARRIS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-4032
Practice Address - Country:US
Practice Address - Phone:704-469-1243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health