Provider Demographics
NPI:1699518316
Name:AMAKOM, IFEOMA C
Entity type:Individual
Prefix:
First Name:IFEOMA
Middle Name:C
Last Name:AMAKOM
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 1:6642 HANSBRINKER DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9738
Mailing Address - Country:US
Mailing Address - Phone:937-344-0721
Mailing Address - Fax:
Practice Address - Street 1:6642 HANSBRINKER DR
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9738
Practice Address - Country:US
Practice Address - Phone:937-344-0721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health