Provider Demographics
NPI:1306592522
Name:NKWOPARA, CHIDINMA JOY
Entity type:Individual
Prefix:
First Name:CHIDINMA
Middle Name:JOY
Last Name:NKWOPARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 WOODHILL CT SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-5041
Mailing Address - Country:US
Mailing Address - Phone:616-216-4457
Mailing Address - Fax:
Practice Address - Street 1:5281 CLYDE PARK AVE SW STE 2
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-9506
Practice Address - Country:US
Practice Address - Phone:616-719-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician