Provider Demographics
NPI:1902153646
Name:NWUFO, CHARLES (MFTI)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:NWUFO
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25808 SWEETLEAF ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4727
Mailing Address - Country:US
Mailing Address - Phone:951-662-5651
Mailing Address - Fax:
Practice Address - Street 1:14338 PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2925
Practice Address - Country:US
Practice Address - Phone:760-354-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 70630101YM0800X
RI3202101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral