Provider Demographics
NPI:1548734312
Name:JOHNSON AGWU, UGO
Entity Type:Individual
Prefix:
First Name:UGO
Middle Name:
Last Name:JOHNSON AGWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6571 HIL MAR DR APT 301
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4136
Mailing Address - Country:US
Mailing Address - Phone:202-422-9792
Mailing Address - Fax:
Practice Address - Street 1:6571 HIL MAR DR APT 301
Practice Address - Street 2:
Practice Address - City:DISTRICT HTS
Practice Address - State:MD
Practice Address - Zip Code:20747-4136
Practice Address - Country:US
Practice Address - Phone:202-422-9792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC5001818501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical