Provider Demographics
NPI:1700332822
Name:IJEOMA, NNAEMEKA (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:NNAEMEKA
Middle Name:
Last Name:IJEOMA
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 ROBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-2108
Mailing Address - Country:US
Mailing Address - Phone:321-418-2246
Mailing Address - Fax:
Practice Address - Street 1:111 W MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4130
Practice Address - Country:US
Practice Address - Phone:407-327-1765
Practice Address - Fax:407-339-2129
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
FL16612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)