MEDICARE: VINCENT PERRIS OMOZEH OYAGHA LPC, NCC

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	101YM0800X	Mental Health Counselor	LPC015349	GA

General Provider Information

NPI Number	:	1891341921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT PERRIS OMOZEH OYAGHA LPC, NCC

Provider Business Mailing Address
First Line	:	1551 ATLANTA HWY STE 161
Second Line	:
City	:	BOGART
State	:	GA
Zip	:	30622-1902
Country	:	US
Telephone Number	:	912-202-3060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 ATLANTA HWY STE 161
Second Line	:
City	:	BOGART
State	:	GA
Zip	:	30622-1902
Country	:	US
Telephone Number	:	912-202-3060
Fax Number	:

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

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	12/04/2025

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