Provider Demographics
NPI:1417243171
Name:UWAIFO, ORITSEGBUBEMI DELPHINE (LPC, NCC,CCMHC, CPCS)
Entity Type:Individual
Prefix:MRS
First Name:ORITSEGBUBEMI
Middle Name:DELPHINE
Last Name:UWAIFO
Suffix:
Gender:F
Credentials:LPC, NCC,CCMHC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 SNAPFINGER WOODS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4039
Mailing Address - Country:US
Mailing Address - Phone:770-695-7475
Mailing Address - Fax:
Practice Address - Street 1:1185 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344
Practice Address - Country:US
Practice Address - Phone:404-477-8846
Practice Address - Fax:404-559-0347
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health