Provider Demographics
NPI:1457942179
Name:OKONKWO, JOACHIN JR
Entity Type:Individual
Prefix:MR
First Name:JOACHIN
Middle Name:
Last Name:OKONKWO
Suffix:JR
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:PO BOX 6072
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-0035
Mailing Address - Country:US
Mailing Address - Phone:202-302-0697
Mailing Address - Fax:
Practice Address - Street 1:0 E 4TH ST STE 42
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-4202
Practice Address - Country:US
Practice Address - Phone:202-302-0697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health