Healthcare Provider Details

I. General information

NPI: 1346079134
Provider Name (Legal Business Name): MR. CHIZOBA UDO OKOLIE-ENWEREJI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E CITY HALL AVE STE 404
NORFOLK VA
23510-1736
US

IV. Provider business mailing address

223 E CITY HALL AVE STE 404
NORFOLK VA
23510-1736
US

V. Phone/Fax

Practice location:
  • Phone: 202-813-7634
  • Fax:
Mailing address:
  • Phone: 202-813-7634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704017184
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: