Provider Demographics
NPI:1427608876
Name:UDEAGHA, JUSTINA E
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:E
Last Name:UDEAGHA
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 1:4101 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-3017
Mailing Address - Country:US
Mailing Address - Phone:734-444-6056
Mailing Address - Fax:734-722-8397
Practice Address - Street 1:6700 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-2039
Practice Address - Country:US
Practice Address - Phone:734-629-5000
Practice Address - Fax:734-722-8397
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty