Provider Demographics
NPI:1598456568
Name:ANOKWU, KELLY CHISOM
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CHISOM
Last Name:ANOKWU
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 1:1914 MICA DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5327
Mailing Address - Country:US
Mailing Address - Phone:240-422-3765
Mailing Address - Fax:
Practice Address - Street 1:1914 MICA DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5327
Practice Address - Country:US
Practice Address - Phone:240-422-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician