Healthcare Provider Details

I. General information

NPI: 1497006225
Provider Name (Legal Business Name): CHUKWUEMEKA B. OKWUOSA MA, LADC, ATSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 AMITY RD STE 104
WOODBRIDGE CT
06525-2200
US

IV. Provider business mailing address

264 AMITY RD STE 104
WOODBRIDGE CT
06525-2200
US

V. Phone/Fax

Practice location:
  • Phone: 203-747-8689
  • Fax: 203-745-0493
Mailing address:
  • Phone: 203-747-8689
  • Fax: 203-745-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number811
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000811
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: