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General NPI Number Information
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NPI Number | 1104426436
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Entity Type | Organization
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Legal Business Name | UGOMOLA LLC
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 313 CLYDIA CT
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City | MIDDLETOWN
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State | DE
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Zip | 19709-8791
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Country | US
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Telephone | 302-725-3120
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Fax | 302-204-1248
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Provider Business Mailing Address
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Address Line | 364 E MAIN ST # 120
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1482
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Country | US
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Telephone | 302-725-3120
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Fax | 302-204-1248
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. KATHRYN UGONNA ALABI
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Credential | LPCMH, LCPC, NCC
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Telephone | 302-725-3120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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