Provider Demographics
NPI:1164991659
Name:IGWE, EUGENE NWABUEZE
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:NWABUEZE
Last Name:IGWE
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 1:4400 BROOKS STREET
Mailing Address - Street 2:
Mailing Address - City:N.E.
Mailing Address - State:DC
Mailing Address - Zip Code:20019
Mailing Address - Country:US
Mailing Address - Phone:202-939-3600
Mailing Address - Fax:
Practice Address - Street 1:4400 BROOKS ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4605
Practice Address - Country:US
Practice Address - Phone:202-939-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103TC1900X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling