Healthcare Provider Details

I. General information

NPI: 1699069609
Provider Name (Legal Business Name): NIKITA DAWN OKUONGHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 04/05/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 WILSHIRE BLVD STE 300
LOS ANGELES CA
90010-1147
US

IV. Provider business mailing address

3055 WILSHIRE BLVD STE 300
LOS ANGELES CA
90010-1147
US

V. Phone/Fax

Practice location:
  • Phone: 310-227-4168
  • Fax: 323-232-2366
Mailing address:
  • Phone:
  • Fax: 323-232-2366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number100531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: