Provider Demographics
NPI:1770736670
Name:IBEKWE, CAROLINE (MA)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:IBEKWE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19422 NESTOR AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2610
Mailing Address - Country:US
Mailing Address - Phone:310-531-4660
Mailing Address - Fax:
Practice Address - Street 1:8939 S SEPULVEDA BLVD STE 460
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3653
Practice Address - Country:US
Practice Address - Phone:310-337-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health