Healthcare Provider Details

I. General information

NPI: 1942914940
Provider Name (Legal Business Name): UGOCHI A OHALE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 10/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3952 W EDDY ST UNIT 2M
CHICAGO IL
60618-5066
US

IV. Provider business mailing address

3952 W EDDY ST UNIT 2M
CHICAGO IL
60618-5066
US

V. Phone/Fax

Practice location:
  • Phone: 773-510-0730
  • Fax:
Mailing address:
  • Phone: 773-510-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180010174
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180010174
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: