Provider Demographics
NPI:1467578385
Name:NWOKEJI-IWUALA, GRACE NGOZI (MASTERS IN EDUCATION)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:NGOZI
Last Name:NWOKEJI-IWUALA
Suffix:
Gender:F
Credentials:MASTERS IN EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MAYWOOD STREET
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119
Mailing Address - Country:US
Mailing Address - Phone:617-566-7419
Mailing Address - Fax:
Practice Address - Street 1:62 MAYWOOD ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2125
Practice Address - Country:US
Practice Address - Phone:617-566-7419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional