Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003054974 |
---|---|
Provider Name | Mr. Benjamin Nkiru Okolo |
First Address | Inglewood, CA 90301-4505 |
Second Address | Inglewood, CA 90301-4505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2009 |
Last Update Date | 29/01/2009 |