Healthcare Provider Details

I. General information

NPI: 1427526664
Provider Name (Legal Business Name): UCHE OKOLIE LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WILSHIRE BOULEVARD 2056
LOS ANGELES CA
90017
US

IV. Provider business mailing address

1001 WILSHIRE BLVD # 2056
LOS ANGELES CA
90017-2415
US

V. Phone/Fax

Practice location:
  • Phone: 818-724-8077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123186
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: