Healthcare Provider Details

I. General information

NPI: 1104472968
Provider Name (Legal Business Name): AMARACHI E. ONYIMA LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 COLUMBIA RD NW
WASHINGTON DC
20009-4779
US

IV. Provider business mailing address

4308 RUSSELL AVE APT 7
MOUNT RAINIER MD
20712-1451
US

V. Phone/Fax

Practice location:
  • Phone: 202-400-7524
  • Fax:
Mailing address:
  • Phone: 503-866-0667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC00591
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: