Provider Demographics
NPI:1932759826
Name:CONA BEHAVIORAL HEALTH CLINIC,
Entity Type:Organization
Organization Name:CONA BEHAVIORAL HEALTH CLINIC,
Other - Org Name:CONA HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:CHINWENDU
Authorized Official - Middle Name:N
Authorized Official - Last Name:EZEORU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC FNP-C
Authorized Official - Phone:301-605-5916
Mailing Address - Street 1:1818 NEW YORK AVE NE STE 230
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1851
Mailing Address - Country:US
Mailing Address - Phone:301-605-5916
Mailing Address - Fax:
Practice Address - Street 1:1818 NEW YORK AVE NE STE 230
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1851
Practice Address - Country:US
Practice Address - Phone:301-605-5916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONA BEHAVIORAL HEALTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-13
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty