Provider Demographics
NPI:1770028680
Name:IBEKWE, JADA MONIQUE
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:MONIQUE
Last Name:IBEKWE
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 1:2224 WATTS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-1951
Mailing Address - Country:US
Mailing Address - Phone:804-247-6560
Mailing Address - Fax:
Practice Address - Street 1:2224 WATTS LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-1951
Practice Address - Country:US
Practice Address - Phone:804-247-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-31
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health