Provider Demographics
NPI:1194390344
Name:ANENE, NKEM NGOZI (PHD)
Entity Type:Individual
Prefix:
First Name:NKEM
Middle Name:NGOZI
Last Name:ANENE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43636 CASTLE CIR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-6149
Mailing Address - Country:US
Mailing Address - Phone:818-219-8883
Mailing Address - Fax:
Practice Address - Street 1:39959 SIERRA HWY
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-3313
Practice Address - Country:US
Practice Address - Phone:661-233-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83332106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty