Healthcare Provider Details

I. General information

NPI: 1619636693
Provider Name (Legal Business Name): OKECHUKWU NWOKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N ELIZABETH ST
LIMA OH
45801-4322
US

IV. Provider business mailing address

212 N ELIZABETH ST
LIMA OH
45801-4322
US

V. Phone/Fax

Practice location:
  • Phone: 937-739-3686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.179019
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: