Provider Demographics
NPI:1194945287
Name:ONIPA PSYCHOLOGICAL AND CONSULTING SERVICES, PLLC
Entity type:Organization
Organization Name:ONIPA PSYCHOLOGICAL AND CONSULTING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAWIYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMBON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-231-2109
Mailing Address - Street 1:PO BOX 46768
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-6768
Mailing Address - Country:US
Mailing Address - Phone:919-231-2109
Mailing Address - Fax:919-231-2152
Practice Address - Street 1:2949 NEW BERN AVE
Practice Address - Street 2:SUITE 112B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1248
Practice Address - Country:US
Practice Address - Phone:919-231-2109
Practice Address - Fax:919-231-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1752251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health