Provider Demographics
NPI:1376332478
Name:NWIGWE, SAMUEL CHUKWUDI
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CHUKWUDI
Last Name:NWIGWE
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 1:105 S SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-3206
Mailing Address - Country:US
Mailing Address - Phone:209-468-8143
Mailing Address - Fax:
Practice Address - Street 1:105 S SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-3206
Practice Address - Country:US
Practice Address - Phone:209-468-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical