Provider Demographics
NPI:1649540675
Name:ALICHE, AZUBIKE INNOCENT (LCSW)
Entity type:Individual
Prefix:MR
First Name:AZUBIKE
Middle Name:INNOCENT
Last Name:ALICHE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6828 WALKWAY CT STE B
Mailing Address - Street 2:
Mailing Address - City:BRYANS ROAD
Mailing Address - State:MD
Mailing Address - Zip Code:20616-6106
Mailing Address - Country:US
Mailing Address - Phone:202-813-0454
Mailing Address - Fax:202-813-0454
Practice Address - Street 1:1325 QUINCY ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2615
Practice Address - Country:US
Practice Address - Phone:202-813-0454
Practice Address - Fax:202-813-0454
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054888001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904009423OtherSTATE LICENSE
DC033478824Medicaid
NJ0602094Medicaid
NJ44SC05488800OtherSTATE LICENSE
DCLC50080921OtherSTATE LICENSE
MD22945OtherSTATE LICENSE