Healthcare Provider Details

I. General information

NPI: 1194367185
Provider Name (Legal Business Name): MAUREEN ONYEWUENYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 GLENCASTLE WAY
SUWANEE GA
30024-4124
US

IV. Provider business mailing address

5421 GLENCASTLE WAY
SUWANEE GA
30024-4124
US

V. Phone/Fax

Practice location:
  • Phone: 770-815-9060
  • Fax:
Mailing address:
  • Phone: 770-815-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC012379
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: