Provider Demographics
NPI:1245919943
Name:NNABUGWU, NNEKA
Entity type:Individual
Prefix:
First Name:NNEKA
Middle Name:
Last Name:NNABUGWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 BLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-4035
Mailing Address - Country:US
Mailing Address - Phone:443-409-6561
Mailing Address - Fax:
Practice Address - Street 1:110 PAINTERS MILL RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4920
Practice Address - Country:US
Practice Address - Phone:443-441-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22676104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker