Provider Demographics
NPI:1255715611
Name:IKEME, CHINENYE
Entity type:Individual
Prefix:
First Name:CHINENYE
Middle Name:
Last Name:IKEME
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 1:309 W MILLBROOK RD
Mailing Address - Street 2:SUITE 161
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4385
Mailing Address - Country:US
Mailing Address - Phone:919-579-7274
Mailing Address - Fax:
Practice Address - Street 1:309 W MILLBROOK RD
Practice Address - Street 2:SUITE 161
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4385
Practice Address - Country:US
Practice Address - Phone:919-559-8690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional