Healthcare Provider Details

I. General information

NPI: 1669924510
Provider Name (Legal Business Name): OKOVIE ULUKPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 RIDGE AVE SW
ATLANTA GA
30315-1640
US

IV. Provider business mailing address

2942 DUNCAN PL
DECATUR GA
30034-6990
US

V. Phone/Fax

Practice location:
  • Phone: 404-688-1350
  • Fax:
Mailing address:
  • Phone: 850-212-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberLPC006838
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC006838
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: