Provider Demographics
NPI:1235421397
Name:IBE, GODWIN E
Entity Type:Individual
Prefix:
First Name:GODWIN
Middle Name:E
Last Name:IBE
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 1:3505 LONG BEACH BLVD # IF
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3907
Mailing Address - Country:US
Mailing Address - Phone:562-988-3436
Mailing Address - Fax:562-988-3439
Practice Address - Street 1:3505 LONG BEACH BLVD # IF
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3907
Practice Address - Country:US
Practice Address - Phone:562-988-3436
Practice Address - Fax:562-988-3439
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)