Provider Demographics
NPI:1730208927
Name:UKONU, DAISY ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:ANN
Last Name:UKONU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12127 MALL BLVD SUITE A #149
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-8513
Mailing Address - Country:US
Mailing Address - Phone:760-261-4755
Mailing Address - Fax:760-261-4756
Practice Address - Street 1:14252 ST ANDREWS DRIVE
Practice Address - Street 2:SUITE #5
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394
Practice Address - Country:US
Practice Address - Phone:760-261-4755
Practice Address - Fax:760-261-4756
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty