Provider Demographics
NPI:1972349728
Name:EZEKWUECHE, CHINWE YVONNE
Entity type:Individual
Prefix:MRS
First Name:CHINWE
Middle Name:YVONNE
Last Name:EZEKWUECHE
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 1:4310 GRETNA CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7701
Mailing Address - Country:US
Mailing Address - Phone:404-216-3681
Mailing Address - Fax:
Practice Address - Street 1:4310 GRETNA CT NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7701
Practice Address - Country:US
Practice Address - Phone:404-216-3681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028871635106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician