Provider Demographics
NPI:1881118206
Name:IGWE, HARRISON UDENSI (PHD, MA, MPA, CAADC,)
Entity type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:UDENSI
Last Name:IGWE
Suffix:
Gender:M
Credentials:PHD, MA, MPA, CAADC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 S MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3837
Mailing Address - Country:US
Mailing Address - Phone:734-585-7970
Mailing Address - Fax:734-585-7977
Practice Address - Street 1:522 S MAPLE RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3837
Practice Address - Country:US
Practice Address - Phone:734-585-7970
Practice Address - Fax:734-585-7977
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451016044101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)