Provider Demographics
NPI:1982196887
Name:NWOSU, ALLIE CHINYERE (MS)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:CHINYERE
Last Name:NWOSU
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7695 PLANTATION BAY DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5182
Mailing Address - Country:US
Mailing Address - Phone:304-894-5696
Mailing Address - Fax:
Practice Address - Street 1:4427 EMERSON ST STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4960
Practice Address - Country:US
Practice Address - Phone:904-398-7015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
FL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)