Provider Demographics
NPI:1629654058
Name:CHIEMELU, KENECHI JONATHAN
Entity type:Individual
Prefix:
First Name:KENECHI
Middle Name:JONATHAN
Last Name:CHIEMELU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FOWLER LN
Mailing Address - Street 2:
Mailing Address - City:SHOHOLA
Mailing Address - State:PA
Mailing Address - Zip Code:18458-3629
Mailing Address - Country:US
Mailing Address - Phone:862-216-6044
Mailing Address - Fax:
Practice Address - Street 1:4604 DAVID DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-2016
Practice Address - Country:US
Practice Address - Phone:862-216-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YP2500X
OHC.2406128101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional