Provider Demographics
NPI:1104426436
Name:UGOMOLA LLC
Entity type:Organization
Organization Name:UGOMOLA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:UGONNA
Authorized Official - Last Name:ALABI
Authorized Official - Suffix:
Authorized Official - Credentials:LPCMH, LCPC, NCC
Authorized Official - Phone:302-725-3120
Mailing Address - Street 1:364 E MAIN ST # 120
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1482
Mailing Address - Country:US
Mailing Address - Phone:302-725-3120
Mailing Address - Fax:302-204-1248
Practice Address - Street 1:313 CLYDIA CT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-8791
Practice Address - Country:US
Practice Address - Phone:302-725-3120
Practice Address - Fax:302-204-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1609206234Medicaid