Healthcare Provider Details

I. General information

NPI: 1598741233
Provider Name (Legal Business Name): CHARLES UKAOMA LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 64TH ST STE 150
EMERYVILLE CA
94608-2267
US

IV. Provider business mailing address

1480 64TH ST STE 150
EMERYVILLE CA
94608-2267
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCI12250518
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4813
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: