Provider Demographics
NPI:1306569637
Name:UGOCHUKWU, LAWRENCIA OLUCHI (PMHMP)
Entity type:Individual
Prefix:
First Name:LAWRENCIA
Middle Name:OLUCHI
Last Name:UGOCHUKWU
Suffix:
Gender:F
Credentials:PMHMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 BROOKSIDE OAKS
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5167
Mailing Address - Country:US
Mailing Address - Phone:443-622-5192
Mailing Address - Fax:443-213-8484
Practice Address - Street 1:4226 BROOKSIDE OAKS
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5167
Practice Address - Country:US
Practice Address - Phone:443-622-5192
Practice Address - Fax:443-213-8484
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210531363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health