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General NPI Number Information
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NPI Number | 1154863181
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Entity Type | Organization
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Legal Business Name | LION HEART PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 415 W GRAND RIVER AVE
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City | EAST LANSING
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State | MI
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Zip | 48823-4201
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Country | US
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Telephone | 517-388-3863
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Fax |
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Provider Business Mailing Address
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Address Line | 336 UNIVERSITY DR
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City | EAST LANSING
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State | MI
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Zip | 48823-4133
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PSYCHIATRIST
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Name | PRINCEWELL UGOJINTA ONWERE
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Credential | DO
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Telephone | 517-388-3863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 5101014956
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License Number State | MI
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