Provider Demographics
NPI:1285984450
Name:NWANGANGA, OKECHUKU ROBERT (LCSW)
Entity type:Individual
Prefix:MR
First Name:OKECHUKU
Middle Name:ROBERT
Last Name:NWANGANGA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:OKECHUKU
Other - Middle Name:ROBERT
Other - Last Name:NWANGANGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1005 E LAS TUNAS DR
Mailing Address - Street 2:#444
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1614
Mailing Address - Country:US
Mailing Address - Phone:323-842-1791
Mailing Address - Fax:
Practice Address - Street 1:1005 E LAS TUNAS DR
Practice Address - Street 2:#444
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1614
Practice Address - Country:US
Practice Address - Phone:323-842-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27072104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker