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General NPI Number Information
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NPI Number | 1932738382
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Entity Type | Individual
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Provider Name | HENRY KOSOROCHI ONYEAKA
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Gender | Male
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Dates
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Enumeration Date | 04/07/2020
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 146 E HOSPITAL DR STE 120A
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4800
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Country | US
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Telephone | 803-936-7460
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Fax | 803-936-7462
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Provider Business Mailing Address
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Address Line | 12 DUNMORE ST
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City | ROXBURY
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State | MA
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Zip | 02119-2814
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Country | US
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Telephone | 857-251-2598
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301511400
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 92079
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 71028
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License Number State | TN
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