Healthcare Provider Details

I. General information

NPI: 1891504601
Provider Name (Legal Business Name): MS. NKECHI ELYSABETH NDU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELYSE NDU AMFT

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HARRISON ST
SAN FRANCISCO CA
94107-1235
US

IV. Provider business mailing address

PO BOX 1003
SAN LEANDRO CA
94577-0111
US

V. Phone/Fax

Practice location:
  • Phone: 628-234-4757
  • Fax:
Mailing address:
  • Phone: 628-234-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: