| Doctor Name: | MR. IFEANYI CHARLES CHUKWU |
| NPI Number: | 1316329287 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.ED. |
| License Number: | MC 60160585 |
| Business Practice Address: | 23745 225th Way Se Ste. #205c Maple Valley, WA - 980385294 |
| Business Phone Number: | 4254336121 |
| Business Fax Number: | 2536381302 |
| Mailing Address: | Po Box 8862, COVINGTON |
| State: | WA |
| Postal Code: | 980420056 |
| Phone Number: | 2062342281 |
| Fax Number: | 2536381302 |
| NPI Enumeration Date: | 06/26/2015 |
| NPI Last Update Date: | 06/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MC 60160585 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |