Provider Demographics
NPI:1245976398
Name:IHEOMA, JOHN IHUEZE
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:IHUEZE
Last Name:IHEOMA
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 1:8700 CENTRAL AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4853
Mailing Address - Country:US
Mailing Address - Phone:144-385-7919
Mailing Address - Fax:240-619-4916
Practice Address - Street 1:8700 CENTRAL AVE STE 300
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4853
Practice Address - Country:US
Practice Address - Phone:443-857-9193
Practice Address - Fax:240-619-4916
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD211111835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health