Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | ||
N | 106S00000X | Behavior Technician | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1174198790 |
---|---|
Provider Name | Ebelechukwu Elochukwu |
First Address | Baltimore, MD 21225-0616 |
Second Address | Upper Marlboro, MD 20774-5350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2021 |
Last Update Date | 26/05/2021 |