Provider Demographics
NPI:1932667060
Name:AZEH, MUMA JOHN (NCC, CCMHC, AND LPC)
Entity Type:Individual
Prefix:MR
First Name:MUMA
Middle Name:JOHN
Last Name:AZEH
Suffix:
Gender:M
Credentials:NCC, CCMHC, AND LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BROKEN ARROW CT
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8126
Mailing Address - Country:US
Mailing Address - Phone:843-304-2958
Mailing Address - Fax:
Practice Address - Street 1:1115 STATE ST
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-4342
Practice Address - Country:US
Practice Address - Phone:803-939-0174
Practice Address - Fax:803-753-5900
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7535101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty