Provider Demographics
NPI:1225760986
Name:EKPETE, CHIKELUBA
Entity Type:Individual
Prefix:
First Name:CHIKELUBA
Middle Name:
Last Name:EKPETE
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 1:3718 NOYES AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1516
Mailing Address - Country:US
Mailing Address - Phone:240-550-0311
Mailing Address - Fax:
Practice Address - Street 1:3718 NOYES AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1516
Practice Address - Country:US
Practice Address - Phone:240-550-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV106374163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)