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General NPI Number Information
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NPI Number | 1942553706
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Entity Type | Individual
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Provider Name | DANIEL IKPECHUKWU MS, ICADC
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Gender | Male
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 5995 OAKBROOK PKWY
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City | NORCROSS
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State | GA
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Zip | 30093-1703
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Country | US
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Telephone | 404-353-7037
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Fax | 770-339-7099
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Provider Business Mailing Address
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Address Line | PO BOX 1262
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City | NORCROSS
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State | GA
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Zip | 30091-1262
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Country | US
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Telephone | 404-353-7037
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 633
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License Number State | GA
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