Provider Demographics
NPI:1306854146
Name:OMABU OKAFOR, RAVITA T (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RAVITA
Middle Name:T
Last Name:OMABU OKAFOR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 NC HIGHWAY 97
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-9322
Mailing Address - Country:US
Mailing Address - Phone:919-819-5971
Mailing Address - Fax:919-366-0333
Practice Address - Street 1:7419 KNIGHTDALE BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8825
Practice Address - Country:US
Practice Address - Phone:919-819-5971
Practice Address - Fax:919-366-0333
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002782Medicaid