Provider Demographics
NPI:1407214919
Name:MEDJU, PAUL ILOLIBI (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ILOLIBI
Last Name:MEDJU
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 MARK MASSENGILL DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-4454
Mailing Address - Country:US
Mailing Address - Phone:919-633-3792
Mailing Address - Fax:
Practice Address - Street 1:1526 MARK MASSENGILL DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4454
Practice Address - Country:US
Practice Address - Phone:919-633-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0113601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical