Healthcare Provider Details

I. General information

NPI: 1659428845
Provider Name (Legal Business Name): CHRISTINA OKPO UMANA MS NCC LPC AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S UNIVERSITY AVE
CARBONDALE IL
62901-2925
US

IV. Provider business mailing address

214 S UNIVERSITY AVE
CARBONDALE IL
62901-2925
US

V. Phone/Fax

Practice location:
  • Phone: 618-351-0743
  • Fax: 618-351-0945
Mailing address:
  • Phone: 618-351-0743
  • Fax: 618-351-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: