Provider Demographics
NPI:1922267608
Name:OKONKWO, NJIDEKA AFULENU I
Entity Type:Individual
Prefix:MS
First Name:NJIDEKA
Middle Name:AFULENU
Last Name:OKONKWO
Suffix:I
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NJIDEKA
Other - Middle Name:AFULENU
Other - Last Name:OKONKWO
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:CCDC
Mailing Address - Street 1:3331 W 54TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4880
Mailing Address - Country:US
Mailing Address - Phone:323-296-2263
Mailing Address - Fax:
Practice Address - Street 1:3756 SANTA ROSALIA DR STE 507
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3656
Practice Address - Country:US
Practice Address - Phone:323-290-2001
Practice Address - Fax:323-290-2003
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104537101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor