Provider Demographics
NPI:1255577037
Name:OSUEKE, IMMACULATA CHIAGHALAM (LLMSW)
Entity type:Individual
Prefix:
First Name:IMMACULATA
Middle Name:CHIAGHALAM
Last Name:OSUEKE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21860 STRATFORD ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2534
Mailing Address - Country:US
Mailing Address - Phone:248-968-3598
Mailing Address - Fax:313-270-2955
Practice Address - Street 1:15800 W MCNICHOLS RD
Practice Address - Street 2:SUITE 223
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3566
Practice Address - Country:US
Practice Address - Phone:313-270-2922
Practice Address - Fax:313-270-2955
Is Sole Proprietor?:No
Enumeration Date:2008-12-27
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802078152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health