Healthcare Provider Details

I. General information

NPI: 1427536515
Provider Name (Legal Business Name): EZINNE NKECHI UWAKWE MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W MILLBROOK RD STE 129
RALEIGH NC
27609-4398
US

IV. Provider business mailing address

405 AVERSBORO RD STE 400
GARNER NC
27529-3869
US

V. Phone/Fax

Practice location:
  • Phone: 919-877-6101
  • Fax:
Mailing address:
  • Phone: 919-264-9769
  • Fax: 866-211-0358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP012132
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: