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General NPI Number Information
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NPI Number | 1902153646
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Entity Type | Individual
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Provider Name | CHARLES NWUFO MFTI
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Gender | Male
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 14338 PARK AVE STE 200
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City | VICTORVILLE
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State | CA
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Zip | 92392-2925
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Country | US
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Telephone | 760-354-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 25808 SWEETLEAF ST
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City | MORENO VALLEY
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State | CA
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Zip | 92553-4727
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Country | US
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Telephone | 951-662-5651
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMF 70630
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 3202
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License Number State | RI
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