Provider Demographics
NPI:1568124550
Name:AFUGBUOM, CHIKAODIL
Entity Type:Individual
Prefix:MISS
First Name:CHIKAODIL
Middle Name:
Last Name:AFUGBUOM
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 1:2250 HOLLY HALL ST APT 204
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3938
Mailing Address - Country:US
Mailing Address - Phone:346-204-3985
Mailing Address - Fax:
Practice Address - Street 1:5702 CALHOUN RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2802
Practice Address - Country:US
Practice Address - Phone:979-574-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-21-187077106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician