Provider Demographics
NPI:1497006225
Name:OKWUOSA, CHUKWUEMEKA B (MA, LADC, ATSA)
Entity Type:Individual
Prefix:
First Name:CHUKWUEMEKA
Middle Name:B
Last Name:OKWUOSA
Suffix:
Gender:M
Credentials:MA, LADC, ATSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 AMITY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2200
Mailing Address - Country:US
Mailing Address - Phone:203-747-8689
Mailing Address - Fax:203-745-0493
Practice Address - Street 1:264 AMITY RD STE 104
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2200
Practice Address - Country:US
Practice Address - Phone:203-747-8689
Practice Address - Fax:203-745-0493
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT811101Y00000X
CT000811101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1497006225Medicaid