Provider Demographics
NPI:1407529811
Name:EJIOGU, NNEKA
Entity Type:Individual
Prefix:
First Name:NNEKA
Middle Name:
Last Name:EJIOGU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NNEKA
Other - Middle Name:
Other - Last Name:OWUSU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4606 JERVIS DR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-5693
Mailing Address - Country:US
Mailing Address - Phone:832-282-3574
Mailing Address - Fax:
Practice Address - Street 1:4606 JERVIS DR
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5693
Practice Address - Country:US
Practice Address - Phone:832-282-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional