Healthcare Provider Details

I. General information

NPI: 1861788184
Provider Name (Legal Business Name): VICTOR OBIDIKE OKORIE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE STE A107
PHOENIX AZ
85051-9568
US

IV. Provider business mailing address

PO BOX 72657
PHOENIX AZ
85050-1028
US

V. Phone/Fax

Practice location:
  • Phone: 602-524-0824
  • Fax: 800-881-7511
Mailing address:
  • Phone: 602-524-0824
  • Fax: 800-881-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-13418
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: