Provider Demographics
NPI:1922339894
Name:OSHEGBO, GODWIN OGHENENYERHOVWO (LCPC)
Entity Type:Individual
Prefix:MR
First Name:GODWIN
Middle Name:OGHENENYERHOVWO
Last Name:OSHEGBO
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4933
Mailing Address - Country:US
Mailing Address - Phone:443-430-1726
Mailing Address - Fax:410-455-0725
Practice Address - Street 1:1151 GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4933
Practice Address - Country:US
Practice Address - Phone:443-430-1726
Practice Address - Fax:410-455-0725
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-16
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC4157OtherSTATE BOARD