Provider Demographics
NPI:1578065256
Name:NKENGLA, POWEIELATEI MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:POWEIELATEI
Middle Name:MARY
Last Name:NKENGLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:POWEIELATEI
Other - Middle Name:MARY
Other - Last Name:IYEGHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7079 KIRBY CRES
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4214
Mailing Address - Country:US
Mailing Address - Phone:334-221-2204
Mailing Address - Fax:
Practice Address - Street 1:224 GREAT BRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3904
Practice Address - Country:US
Practice Address - Phone:757-547-9334
Practice Address - Fax:757-819-6292
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4020C1041C0700X
VA09040102171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical