Provider Demographics
NPI:1568046852
Name:IGBOEGWU, CHIOMA (PHD, LCAS-A)
Entity Type:Individual
Prefix:DR
First Name:CHIOMA
Middle Name:
Last Name:IGBOEGWU
Suffix:
Gender:F
Credentials:PHD, LCAS-A
Other - Prefix:DR
Other - First Name:CHIOMA
Other - Middle Name:IHUOMA
Other - Last Name:IGBOEGWU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD CLINPSY LCAS-A
Mailing Address - Street 1:1365 WESTGATE CENTER DR. UNIT - 2
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-473-7172
Mailing Address - Fax:
Practice Address - Street 1:1365 WESTGATE CENTER DR. UNIT - 2
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-473-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27116101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)