Doctor Name: | BENEDICT C IJOMAH |
NPI Number: | 1083911762 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW-C |
License Number: | 09832 |
Business Practice Address: | 4607 69th Ave Hyattsville, MD - 207842123 |
Business Phone Number: | 3013860014 |
Business Fax Number: | 3013860018 |
Mailing Address: | 4607 69th Ave, HYATTSVILLE |
State: | MD |
Postal Code: | 207842123 |
Phone Number: | 3013860014 |
Fax Number: | 3013860018 |
NPI Enumeration Date: | 02/16/2011 |
NPI Last Update Date: | 02/16/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 09832 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |