Healthcare Provider Details

I. General information

NPI: 1356483838
Provider Name (Legal Business Name): CHRIS ONYESE OGBONNAH MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 DELAWARE AVE
WILMINGTON DE
19806
US

IV. Provider business mailing address

1213 DELAWARE AVE
WILMINGTON DE
19806
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-3948
  • Fax: 302-652-8297
Mailing address:
  • Phone: 302-652-3948
  • Fax: 302-652-8297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: