Provider Demographics
NPI:1831716703
Name:IGWE, BRIGHT CHUKWEMEKA
Entity type:Individual
Prefix:
First Name:BRIGHT
Middle Name:CHUKWEMEKA
Last Name:IGWE
Suffix:
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 1:4909 WATERS EDGE DRIVE SUITE 203
Mailing Address - Street 2:4909 WATERS EDGE DR. SUITE 203
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606
Mailing Address - Country:US
Mailing Address - Phone:919-247-2312
Mailing Address - Fax:
Practice Address - Street 1:4909 WATERS EDGE DRIVE SUITE 203
Practice Address - Street 2:4909 WATERS EDGE DR. SUITE 203,
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606
Practice Address - Country:US
Practice Address - Phone:919-247-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26405101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)