Provider Demographics
NPI:1790322204
Name:GODWIN, ONYEKA
Entity Type:Individual
Prefix:
First Name:ONYEKA
Middle Name:
Last Name:GODWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 TINTAGEL LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1318
Mailing Address - Country:US
Mailing Address - Phone:281-736-3632
Mailing Address - Fax:
Practice Address - Street 1:4722 TINTAGEL LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1318
Practice Address - Country:US
Practice Address - Phone:281-736-3632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional