Provider Demographics
NPI:1952153231
Name:EGBULEM, CHINONYE DONNA (LCSWA)
Entity Type:Individual
Prefix:
First Name:CHINONYE
Middle Name:DONNA
Last Name:EGBULEM
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 W SUGAR CREEK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6102
Mailing Address - Country:US
Mailing Address - Phone:919-815-6526
Mailing Address - Fax:
Practice Address - Street 1:1913 J N PEASE PL STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4537
Practice Address - Country:US
Practice Address - Phone:980-308-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0203481041C0700X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374J00000XNursing Service Related ProvidersDoula