Provider Demographics
NPI:1952185738
Name:AUDIENCE WELLNESS AND BEHAVIORAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:AUDIENCE WELLNESS AND BEHAVIORAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:CHIKADIBIA
Authorized Official - Last Name:ONUKOGU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:443-909-4407
Mailing Address - Street 1:9616 ORPIN RD APT 102
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2473
Mailing Address - Country:US
Mailing Address - Phone:443-909-4407
Mailing Address - Fax:
Practice Address - Street 1:9616 ORPIN RD APT 102
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-2473
Practice Address - Country:US
Practice Address - Phone:443-909-4407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty