Provider Demographics
NPI:1285434944
Name:IREH, UCHENDU TEMPLE
Entity type:Individual
Prefix:MR
First Name:UCHENDU
Middle Name:TEMPLE
Last Name:IREH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2584 DEL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2956
Mailing Address - Country:US
Mailing Address - Phone:404-697-1486
Mailing Address - Fax:
Practice Address - Street 1:2584 DEL RIDGE DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2956
Practice Address - Country:US
Practice Address - Phone:404-697-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician