Healthcare Provider Details

I. General information

NPI: 1285501924
Provider Name (Legal Business Name): IKECHUKWU NWAKANMA THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 BELLEVILLE AVE
BALTIMORE MD
21207-6945
US

IV. Provider business mailing address

5535 BELLEVILLE AVE
BALTIMORE MD
21207-6945
US

V. Phone/Fax

Practice location:
  • Phone: 443-502-0825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: