Provider Demographics
NPI:1598741233
Name:UKAOMA, CHARLES (LPCC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:UKAOMA
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 LAS CASITAS DRIVE
Mailing Address - Street 2:# 2503
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004-3219
Mailing Address - Country:US
Mailing Address - Phone:704-668-6401
Mailing Address - Fax:800-483-0039
Practice Address - Street 1:74710 HIGHWAY 111 STE 102
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3820
Practice Address - Country:US
Practice Address - Phone:760-270-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI12250518101YA0400X
NC4813101YP2500X, 101YP2500X
CA9248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)