MEDICARE: HELEN UFUOMA IBIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.031119	IL

General Provider Information

NPI Number	:	1417802299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELEN UFUOMA IBIM

Provider Business Mailing Address
First Line	:	430 BALLYSHANNON DR
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-6575
Country	:	US
Telephone Number	:	678-972-7475
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 BALLYSHANNON DR
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-6575
Country	:	US
Telephone Number	:	678-972-7475
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	02/26/2026

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Directions to “ HELEN UFUOMA IBIM ” Practice Location

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