Provider Demographics
NPI:1164144283
Name:IMOH, MFRIE-EMEM IFIOK (RIC)
Entity Type:Individual
Prefix:
First Name:MFRIE-EMEM
Middle Name:IFIOK
Last Name:IMOH
Suffix:
Gender:F
Credentials:RIC
Other - Prefix:
Other - First Name:MFRIE
Other - Middle Name:
Other - Last Name:IMOH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RIC
Mailing Address - Street 1:5893 ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3619
Mailing Address - Country:US
Mailing Address - Phone:703-730-0302
Mailing Address - Fax:703-730-0300
Practice Address - Street 1:5893 ANTHONY DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3619
Practice Address - Country:US
Practice Address - Phone:703-730-0302
Practice Address - Fax:703-730-0300
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health