Provider Demographics
NPI:1407657125
Name:AGWANIHU, STANLEY O (DHA)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:O
Last Name:AGWANIHU
Suffix:
Gender:
Credentials:DHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HAMILTON ST APT 315
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2893
Mailing Address - Country:US
Mailing Address - Phone:551-226-3603
Mailing Address - Fax:
Practice Address - Street 1:1515 W CORNWALLIS DR STE 207
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-6334
Practice Address - Country:US
Practice Address - Phone:551-226-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0210461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty