Provider Demographics
NPI:1629386883
Name:NWALA, EMMANUEL (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:
Last Name:NWALA
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 S LINCOLN ST STE L1
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4373
Mailing Address - Country:US
Mailing Address - Phone:605-725-5505
Mailing Address - Fax:
Practice Address - Street 1:404 S LINCOLN ST STE L1
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4373
Practice Address - Country:US
Practice Address - Phone:605-725-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-7407101YP2500X
ND801-9-1-14101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional