Provider Demographics
NPI:1912478165
Name:ONYIA, SYLVESTER M (LMHC, RN)
Entity Type:Individual
Prefix:
First Name:SYLVESTER
Middle Name:M
Last Name:ONYIA
Suffix:
Gender:M
Credentials:LMHC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 JUAN TABO BLVD NE STE AD
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2966
Mailing Address - Country:US
Mailing Address - Phone:505-295-3159
Mailing Address - Fax:505-266-2502
Practice Address - Street 1:2617 JUAN TABO BLVD NE STE AD
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2966
Practice Address - Country:US
Practice Address - Phone:505-295-3159
Practice Address - Fax:505-266-2502
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-CTL0200071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health