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General NPI Number Information
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NPI Number | 1104324664
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Entity Type | Individual
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Provider Name | DONATUS IKECHUKWU EZENNEKA
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Gender | Male
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 2122 AUSTELL RD SW
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City | MARIETTA
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State | GA
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Zip | 30008-4151
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Country | US
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Telephone | 762-233-4869
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Fax |
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Provider Business Mailing Address
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Address Line | 2122 AUSTELL RD SW
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City | MARIETTA
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State | GA
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Zip | 30008-4151
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Country | US
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Telephone | 857-260-8805
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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