Provider Demographics
NPI:1821616889
Name:ENEANYA, AWELE
Entity type:Individual
Prefix:
First Name:AWELE
Middle Name:
Last Name:ENEANYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-1133
Mailing Address - Country:US
Mailing Address - Phone:651-237-2391
Mailing Address - Fax:
Practice Address - Street 1:708 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-1133
Practice Address - Country:US
Practice Address - Phone:651-237-2391
Practice Address - Fax:612-446-5770
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health