Provider Demographics
NPI:1245907047
Name:CHINEDO, AMAKA
Entity type:Individual
Prefix:
First Name:AMAKA
Middle Name:
Last Name:CHINEDO
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 1:144 INTERSTATE 45 N APT 713
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-3640
Mailing Address - Country:US
Mailing Address - Phone:713-518-7692
Mailing Address - Fax:
Practice Address - Street 1:144 INTERSTATE 45 N APT 713
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-3640
Practice Address - Country:US
Practice Address - Phone:713-518-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health