Provider Demographics
NPI:1295971075
Name:ONWUEMELIE, BERNARD IKE (LMSW, CAADC)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:IKE
Last Name:ONWUEMELIE
Suffix:
Gender:M
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20291 TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1351
Mailing Address - Country:US
Mailing Address - Phone:313-753-2292
Mailing Address - Fax:313-532-4608
Practice Address - Street 1:20291 TRINITY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1351
Practice Address - Country:US
Practice Address - Phone:313-753-2292
Practice Address - Fax:313-532-4608
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2014-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801084613101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI80-0-89-8408-0OtherBLUE CROSS BLUE SHIELD, BLUE CARE NETWORK OF MICHIGAN