Healthcare Provider Details

I. General information

NPI: 1083362420
Provider Name (Legal Business Name): OLIVIA UWAMAHORO PHD, NCC, LPC, CPCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLIVIA UWAMAHORO WILLIAMS PHD, NCC, LPC, CPCS

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 THUNDER RIDGE DR
ACWORTH GA
30101-2277
US

IV. Provider business mailing address

510 THUNDER RIDGE DR
ACWORTH GA
30101-2277
US

V. Phone/Fax

Practice location:
  • Phone: 901-827-2746
  • Fax:
Mailing address:
  • Phone: 901-827-2746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010719
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: