Provider Demographics
NPI:1982433132
Name:AIZENOFE, OMOIKE ERIC (MDIV BCC)
Entity type:Individual
Prefix:
First Name:OMOIKE
Middle Name:ERIC
Last Name:AIZENOFE
Suffix:
Gender:M
Credentials:MDIV BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530513
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75053-0513
Mailing Address - Country:US
Mailing Address - Phone:325-232-4205
Mailing Address - Fax:
Practice Address - Street 1:145 W PIONEER PKWY APT 2022
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4977
Practice Address - Country:US
Practice Address - Phone:325-232-4205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral