Healthcare Provider Details

I. General information

NPI: 1184489577
Provider Name (Legal Business Name): CHIDIMMA WINIFRED UKEJE APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15603 PARTHENIA ST APT 108
NORTH HILLS CA
91343-4993
US

IV. Provider business mailing address

15603 PARTHENIA ST APT 108
NORTH HILLS CA
91343-4993
US

V. Phone/Fax

Practice location:
  • Phone: 424-375-9155
  • Fax:
Mailing address:
  • Phone: 424-375-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15710
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: