Provider Demographics
NPI:1972636694
Name:IKEDIASHI-AKOMAH, VIVIAN ONYEMAECHI (MFTI)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:ONYEMAECHI
Last Name:IKEDIASHI-AKOMAH
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1425
Mailing Address - Country:US
Mailing Address - Phone:818-902-5315
Mailing Address - Fax:
Practice Address - Street 1:6501 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1425
Practice Address - Country:US
Practice Address - Phone:818-902-5315
Practice Address - Fax:818-780-6562
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional