Provider Demographics
NPI:1255767679
Name:UGWUEGBU, DENIS CHIMA (PHD/MA)
Entity type:Individual
Prefix:DR
First Name:DENIS
Middle Name:CHIMA
Last Name:UGWUEGBU
Suffix:
Gender:M
Credentials:PHD/MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7516 MYRTLE CT
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48198-9316
Mailing Address - Country:US
Mailing Address - Phone:734-478-6998
Mailing Address - Fax:
Practice Address - Street 1:7516 MYRTLE CT
Practice Address - Street 2:
Practice Address - City:SUPERIOR TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48198-9316
Practice Address - Country:US
Practice Address - Phone:734-478-6998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015269103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical