Provider Demographics
NPI:1134813264
Name:NKWONTA, CHUKWUEMEKA RENNER
Entity type:Individual
Prefix:
First Name:CHUKWUEMEKA
Middle Name:RENNER
Last Name:NKWONTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-2431
Mailing Address - Country:US
Mailing Address - Phone:757-214-2361
Mailing Address - Fax:
Practice Address - Street 1:914 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-2431
Practice Address - Country:US
Practice Address - Phone:757-214-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health