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General NPI Number Information
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NPI Number | 1245976398
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Entity Type | Individual
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Provider Name | MR. JOHN IHUEZE IHEOMA
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Gender | Male
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 8700 CENTRAL AVE STE 300
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City | LANDOVER
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State | MD
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Zip | 20785-4853
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Country | US
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Telephone | 443-857-9193
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Fax | 240-619-4916
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Provider Business Mailing Address
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Address Line | 8700 CENTRAL AVE STE 300
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City | LANDOVER
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State | MD
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Zip | 20785-4853
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Country | US
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Telephone | 144-385-7919
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Fax | 240-619-4916
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 211111835
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License Number State | MD
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