Provider Demographics
NPI:1063949170
Name:CHUKWUEMEKA, ROY D (LAC)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:D
Last Name:CHUKWUEMEKA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 S GILBERT RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5233
Mailing Address - Country:US
Mailing Address - Phone:480-507-8619
Mailing Address - Fax:480-507-8618
Practice Address - Street 1:1107 S GILBERT RD STE 104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5233
Practice Address - Country:US
Practice Address - Phone:480-507-8619
Practice Address - Fax:480-507-8618
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-15219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health