Healthcare Provider Details

I. General information

NPI: 1417243171
Provider Name (Legal Business Name): ORITSEGBUBEMI DELPHINE UWAIFO LPC, NCC,CCMHC, CPCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 CLEVELAND AVE
EAST POINT GA
30344
US

IV. Provider business mailing address

5036 SNAPFINGER WOODS DR STE 201
DECATUR GA
30035-4039
US

V. Phone/Fax

Practice location:
  • Phone: 404-477-8846
  • Fax: 404-559-0347
Mailing address:
  • Phone: 770-695-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC007157
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: