Healthcare Provider Details

I. General information

NPI: 1619244068
Provider Name (Legal Business Name): YOHANNA E OKOLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 TREMONT ST
ROXBURY MA
02120-3432
US

IV. Provider business mailing address

25 DALE ST
ROXBURY MA
02119-2287
US

V. Phone/Fax

Practice location:
  • Phone: 617-989-3108
  • Fax:
Mailing address:
  • Phone: 617-710-0370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: