Provider Demographics
NPI:1346079134
Name:OKOLIE-ENWEREJI, CHIZOBA UDO
Entity type:Individual
Prefix:MR
First Name:CHIZOBA
Middle Name:UDO
Last Name:OKOLIE-ENWEREJI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E CITY HALL AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1736
Mailing Address - Country:US
Mailing Address - Phone:202-813-7634
Mailing Address - Fax:
Practice Address - Street 1:223 E CITY HALL AVE STE 404
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1736
Practice Address - Country:US
Practice Address - Phone:202-813-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704017184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health